Bilateral House Flap Anoplasty for Severe Anal Stenosis: Our Experience at a Tertiary Care Center in India.

Anal stenosis is a narrowing of the anal canal that can result from either an anatomic stricture or functional obstruction. While postoperative and idiopathic causes are more common, chemically induced anal stenosis following the application of traditional medicine for hemorrhoids is rare and often severe. Literature on this etiology and its management is scarce. This case highlights the need for health education and raises awareness among general surgeons who may encounter such cases, particularly in regions where traditional medicine is widely used. We report the case of a 38-year-old gentleman from the state of Bihar who presented with a three-month history of progressive difficulty in passing feces and flatus, requiring digital evacuation. These symptoms were also accompanied by intermittent abdominal distension. Notably, he had undergone traditional medicine application for hemorrhoidal treatment four months prior, which initially resulted in ulceration and subsequently healed with scarring. He had no history of diabetes, smoking, or other chronic illnesses. Physical examination confirmed severe anal stenosis. The patient underwent bilateral House advancement flap anoplasty, performed by a general surgeon, with excellent functional outcomes. The most common cause of anal stenosis is hemorrhoidectomy, followed by other anorectal surgeries, anorectal diseases, and radiotherapy. Diagnosis is primarily clinical. While mild cases can be managed conservatively, moderate to severe cases require surgical intervention, with advancement flap anoplasty being a preferred approach.  Health education is essential to prevent complications arising from inappropriate treatments. House advancement flap anoplasty is a viable and effective surgical option for anal stenosis in resource-limited settings due to its technical simplicity and favorable outcomes.