Clinical, functional and morphologic evaluation of patients undergoing lateral sphincterotomy for chronic anal fissure treatment. Identification of factors that can interfere with fecal continence

Fernandes, Graziela Olivia da Silva; Murad-Regadas, Sthela Maria; Regadas, F. S. P.; Rodrigues, Lusmar Veras; Dealcanfreitas, Iris Daiana; Pereira, Jacyara de Jesus Rosa; Holanda, Erico de Carvalho; Filho, Francisco Sergio Pinheiro Regadas

doi:10.1016/j.jcol.2014.05.006

Cited by 4 publications

(1 citation statement)

References 29 publications

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“…Available research focusing on LIS outcomes in female patients are few. Regadas et al [46] and Fernandes et al [47] analyzed respectively a series on 31 and 36 female patients affected by CAF hypertonic IAS, without FI or previous proctological procedure, who underwent LIS extended to the apex of the fissure; they observed, in the 52-53% of cases. The authors highlighted, with a post-operative evaluation endoanal ultrasound (EAUS), that if LIS extension was greater than 20-25% of the IAS length (corresponding to less than 1 cm), the incidence of FI was significantly higher.…”

Section: Discussionmentioning

confidence: 99%

Safety and effectiveness of saving sphincter procedure in the treatment of chronic anal fissure in female patients

et al. 2021

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Introduction Lateral internal sphincterotomy (LIS) is still the approach of choice for the treatment of chronic anal fissure (CAF) regardless to the internal anal sphincter tone but it is burdened by high risk post-operative faecal incontinence (FI). In female patient there are some anatomical and functional differences of the sphinteric system which make them more at risk of FI and vaginal birth could cause sphinteric lesions affecting the anal continence function. The aim of our study is to evaluate the results of saving sphincter procedure as treatment for female patients affected by CAF. Methods We studied 110 female patients affected by CAF undergone fissurectomy and anoplasty with V–Y cutaneous flap advancement associating pharmacological sphincterotomy in patients with hypertonic IAS. The follow up was at least for 2 years. The goals were patient’s complete healing, the evaluation of FI, recurrence rate and manometry parameters. Results All wounds healed within 40 days after surgery. We recorded 8 cases of recurrences 6 healed with medical therapy and 2 with dilatation. We recorded 2 “de novo” temporary and low grade post-operative cases of FI. Post-operative value of MRP were unmodified in patient with normotonic IAS but significantly lower at 12 months follow up as compared with the pre-operative ones in patients with hypertonic IAS; after 24 months from surgery MRP values were within the normal range. Conclusion The fissurectomy and anoplasty with V–Y cutaneous flap alone or in association with a pharmacological sphincterotomy in patients with hypertonic IAS may represent an effective approach for the treatment of CAF in female patients.

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Section: Discussionmentioning

confidence: 99%