Transanal anorectal stricturoplasty using the Heineke-Mikulicz principle: a novel technique.

AIM: Current surgical options for the treatment of rectal stricture are either technically difficult or result in a high rate of recurrence. We describe the results of a simple and potentially effective technique of transanal stricturoplasty using the Heineke-Mikulicz principle. METHOD: The medical records and a prospectively maintained database of patients with rectal stricture were searched. Those who underwent transanal stricturoplasty for an anorectal stricture from 2007 to 2013 were studied retrospectively. Morbidity, length of hospital stay and the rates of success and recurrence were recorded. RESULTS: Fifteen patients with a symptomatic rectal stricture who failed dilatation underwent transanal stricturoplasty. The types of stricture included strictures in Crohn's disease (n = 7) and anastomotic stricture after stapled ileoanal anastomosis for ulcerative colitis (n = 4), after stapled hemorrhoidopexy (n = 3) and after low anterior resection for rectal cancer (n =1). The median (range) distance of the stricture from the dentate line was 4 (0-6) cm. Recurrence of symptoms after anal dilatation occurred at a median of 3 (1-4) weeks. The median follow up after transanal stricturoplasty was 21 (6-88) months. Two patients had symptomatic recurrence at 12 months and both underwent a repeat transanal stricturoplasty, resulting in persistent patency of the strictured area at the time of the last follow up, 10 and 26 months, respectively, after repeat transanal stricturoplasty. The remaining 13 had a satisfactory result. CONCLUSION: Despite the retrospective nature of this report and the small sample size and short follow up, the results strongly suggest that transanal Heineke-Mikulicz-type stricturoplasty is a promising treatment for this important condition. This operation is easy to perform and may result in success.

Ovicidal action of oxfendazole on sheep nematodes.

Groups of five sheep naturally infested with gastrointestinal nematodes were dosed with oxfendazole at the rates of 2.5, 3.5, or 4.5 mg per kg and a similar group of five kept as controls. Frequent observations were made on worm egg output and the hatchability of the eggs passed. The first ovicidal activity was apparent five hours after treatment. Within eight hours 99.7 per cent or more of the eggs voided were sterile and by 30 hours there was a 99.9 per cent reduction in the numbers of larvae hatching compared with the controls. Within three days of dosing the faeces of the treated sheep were negative for worm eggs.