Sarafoff's anoplasty for incontincence following Whitehead's haemorrhoidectomy

The purpose of our study was to ascertain whether Sarafoff's anoplasty is a valid option for anal ectropion (eversion), in which mucosal prolapse causes continuous mucus discharge and faecal incontinence from loss of sensitivity due to anal skin removal. A retrospective evaluation was made of 12 patients (8 female and 4 male, mean follow-up time 8.3 years, range 2–12 years) who, from 1984 through 1997, underwent Sarafoff's anoplasty for anal ectropion following Whitehead's haemorroidectomy, which in 5 cases had been combined with prolapsectomy. Eight patients complained of incontinence to solid faeces (Miller's score 7–9), and the remaining 4 of incontinence to liquid faeces and gas (Miller's score 1–6). The median score for preoperative incontincence was 7. All patients underwent pre- and postoperative manometric evaluation. Sarafoff's anoplasty consists of a cutaneous and subcutaneous circular incision to a depth equal to that of the sphincteric apparatus (1–4 cm), and at a distance of 1–2 cm from the everted anal or rectal mucosa, with analcoccygeal ligament sectioning. The wound created is made to heal without sutures. Scar retraction, together perhaps with the action of the levator ani muscle, raises the eversion, thus restoring the anoderm of the distal anal canal. On comparing values before and after Sarafoff's anoplasty, a significant improvement was found in: mucus secretion (P < 0.01), ectropion (P < 0.01), and degree of postoperative continence, with a median score of 2 (P < 0.01). No statistical difference was found between mean manometric parameters before and after surgery. Sarafoff's anoplasty in selected patients with ectropion combined with faecal incontinence due to loss of anal sensitivity, is a simple procedure with good long-term results, and without important complications. Received: 19 January 1999 / Accepted in revised form: 13 May 1999