Functional and quality-of-life outcomes following flap surgery for anal canal stenosis caused by traumatic and non-traumatic factors: A comparative analysis.

BACKGROUND

Anal canal stenosis is a functionally disabling condition that results in impaired continence, constipation, and decreased quality of life. Although most cases arise after anorectal surgery, high-energy blast trauma (HEBT) represents a distinct etiology characterized by extensive tissue loss and neuromuscular injury. Long-term outcomes of anoplasty in this setting remain insufficiently described. This retrospective study evaluated functional and quality-of-life outcomes following flap anoplasty for anal stenosis of both postoperative and trauma-related origins.

METHODS

All patients who underwent anoplasty between 2008 and 2015 with ≥12 months of follow-up were included. Functional status was assessed preoperatively and at 12 months postoperatively using the Modified Wexner Score, Wexner Constipation Scale, and the Fecal Incontinence Quality of Life (FIQL) questionnaire. Sphincter morphology was evaluated using endoanal ultrasonography. Statistical analyses included paired tests, effect size calculations, and multivariable logistic regression to identify independent predictors of good continence (Wexner score ≤5).

RESULTS

Thirty-seven patients met the inclusion criteria: 27 with postoperative stenosis and 10 with blast-related trauma. Ano-plasty resulted in overall improvement in continence, constipation, and FIQL scores. However, functional recovery differed significantly by etiology: postoperative patients experienced substantial improvement, whereas blast-injured patients achieved only modest gains, reflecting persistent neuromuscular and fibrotic damage. Trauma cases demonstrated lower FIQL scores (14.7 vs. 16.8), higher constipation scores (8.1 vs. 7.2), and increased rates of fecal incontinence (20% vs. 11.1%). Sphincter integrity and shorter stricture length independently predicted good continence, while blast mechanism and advanced age were associated with reduced improvement.

CONCLUSION

Anoplasty provides meaningful functional benefits in patients with anal stenosis; however, recovery is significantly attenuated in survivors of high-energy trauma. These findings underscore the importance of etiology-based planning, thorough sphinc-ter evaluation, and realistic patient counseling.