ORIGINAL ARTICLE   

Chirurgia 2019 October;32(5):217-20

DOI: 10.23736/S0394-9508.18.04881-7

Copyright © 2018 EDIZIONI MINERVA MEDICA

lingua: Inglese

A new surgical approach in circumferential anal giant condyloma acuminatum: analysis of 13 cases

Lorenzo RIPAMONTI ¹, Matteo MATERNINI ¹ ✉, Marco CHIARELLI ², Angelo GUTTADAURO ¹

¹ Unit of General Surgery, Zucchi Clinical Institutes, University of Milano-Bicocca, Monza, Monza-Brianza, Italy; ² Unit of General Surgery, Department of Surgery, Alessandro Manzoni Hospital, Lecco, Italy

BACKGROUND: Perianal giant condyloma acuminatum (GCA) is a rare clinical condition related to low-risk human papillomavirus (HPV) characterized by a circumferential, exophytic, cauliflower-like mass. GCA is not a malignant lesion by histologic criteria but often shows a propensity to compress or infiltrate adjacent tissues and harbor tumor foci with high potential for malignant transformation (30-56%). Local extent of tumor invasion, not malignant histology, had the greatest impact on morbidity. Local full thickness surgical excision with 1 cm macroscopically negative margins is presently considered the most appropriate treatment for this type of lesion.
METHODS: This study reports successful treatment of 13 patients (11 males, 2 females, mean age 38.5 years old) with a new surgical approach. This technique consists in the removal of a mucocutaneous cylinder containing the entire lesion with 1 cm of disease-free margin both on the perianal skin and on the mucosa of the anal canal. Subsequently, the mucosa of the anal canal is sutured to the external margin of the internal sphincter with detached points in absorbable material. The anesthetic technique was spinal anesthesia.
RESULTS: The early postoperative period was uneventful in all 13 patients. Complete healing occurred in 40 days. Two months from surgery, no findings of anal stenosis were reported except for 2 patients (due to an incorrect postoperative management). No findings of mucosal ectropion two months after surgery. At the 1-year follow-up, there was no recurrence of condylomatosis in any patient.
CONCLUSIONS: This procedure seems to combine technical simplicity, rapid discharge, low complication rates (no anal stenosis nor mucosal ectropion) and without recurrence of condylomatosis after 1-year follow-up. For all these reasons we think it might be a valid therapy for GCA.

KEY WORDS: Condylomata acuminata; Buschke-Lowenstein tumor; Papillomaviridae; Margins of excision; Perineum