Background
Various anal retractors are available to facilitate retraction of the anus. Commonly used retractors include Parks’, Eisenhammer and Lone Star®. The Lone Star® retractor provides stable retraction without needing an assistant to hold it. We describe an alternative method when a Lone Star® is unavailable.
Technique
The patient is positioned appropriately for the operation (ie Lloyd-Davies or jack-knife). Thick suture material such as size 0 polypropylene or silk is used to suture the perianal skin to the anal skin/mucosa (Fig 1). The amount of perianal skin and anal mucosa that is included should be based on the size of the anal canal, the thickness of the skin/mucosa and the purpose of anal retraction. We use six sutures, corresponding to the even numbers of the clock (2, 4, 6, 8, 10 and 12 o’clock positions).
Figure 1.
Anal retraction sutures stitching the perianal skin to the anal mucosa
Discussion
Lone Star® retractors are very useful for anal retraction but the hooks may prick the surgeon or assistant while inserting or removing them. Sometimes it is hard to find them in operating theatres. The technique described here is not our invention: the senior author learnt it while working in Cleveland, OH, US. It is a useful technique, easily reproducible, simple and does not require any specialist equipment. In our experience, it is safer than the Lone Star®. Very occasionally, it may cause skin laceration that can be minimised by tying the sutures over a bolster of cotton gauze.