Revision of strictured anoplasty

Some children develop a tight stricture at the junction of the skin and the neoanus after an otherwise successful posterior sagital anorectoplasty. If the scarring is truly skin level only ( a few mm thick), then a Heineke-Mikulicz type plasty at 3, 6, 9, and 12 o’clock is very useful.  



Silk sutures are placed on either side of the 3 o’clock position, and the stricture cut horizontally (in this image)




Closure of the transverse 3 o’clock incision vertically (Heineke-Mikulicz)



Completed anoplasty revision










A deeper stricture needs a full rectal re-mobilization.   In that case, put sutures around the circumference and mobilize the entire neoanus and rectum; a tiny posterior sagittal incision is often added (which will ultimately be incorporated into the anoplasty  so at the conclusion there is no posterior or anterior suture line, just the anoplasty).