Long-term Outcomes of Heineke-Mikulicz Anoplasty for Treatment of Skin-level Strictures.

Background: The Heineke-Mikulicz anoplasty (HMA) is a technique for addressing skin-level postoperative strictures following posterior sagittal anorectoplasty (PSARP) and posterior sagittal anorectovaginourethroplasty (PSARVUP). We aimed to evaluate the long-term outcomes with HMA as a treatment for postoperative anal strictures.

Methods: A retrospective review was conducted for patients with a history of ARM who underwent HMA for skin-level anal strictures. Data were collected regarding indication for HMA, most recent anorectoplasty preceding HMA (primary or redo), timing of HMA, extent of stricturoplasty, change in caliber of anus, and postoperative outcomes. Descriptive statistical analysis was performed.

Results: From 2015 to 2024, 138 patients with history of ARM underwent HMA. Median age at time of HMA was 4 years [IQR 2-6] with median follow up time of 3.0 years [IQR 1.0-4.0]. HMA was performed after primary PSARP or PSARVUP in 29 % of patients and after redo surgery in 61.6 %. The minimum time between index operation and initial HMA was 2 months and the median was 5 months [IQR 3-24]. 14.5 % of patients required repeat HMA. The median time between index operation and repeat HMA was 24 months (IQR 12-39). There was a significant trend between number of quadrants where HMA was performed and need for repeat HMA.

Conclusion: HMA is a safe and durable procedure that can treat skin-level postoperative anal strictures in most patients following PSARP and PSARVUP. Patients can frequently be managed with a one-time HMA. HMA should be considered as an alternative to dilation for skin-level anal strictures, especially in an older patient after redo surgery.