Comparative Study of Conventional Lateral Internal Sphincterotomy, V-Y Anoplasty, and Tailored Lateral Internal Sphincterotomy with V-Y Anoplasty in the Treatment of Chronic Anal Fissure

Magdy, Alaa; Nakeeb, Ayman El; Fouda, El Yamani; Youssef, Mohamed A.; Farid, Mohamed

doi:10.1007/s11605-012-1984-5

Cited by 36 publications

(9 citation statements)

References 41 publications

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“…Therefore, alternative techniques have been proposed, but are considered as being associated with a lower level of evidence. Among those techniques are the ’tailored’ lateral sphincterotomy [ 5 ], pneumatic balloon dilation [ 6 ], and foremost surgical techniques that do not divide the internal anal sphincter, namely, a subcutaneous fissurotomy [ 7 ], fissurectomy [ 8 , 9 ] and fissurectomy associated with anoplasty, the so-called V-Y cutaneous flap [ 10 ] or mucosal flap [ 9 , 11 ]. Many authors initially offered those techniques to patients with high risk of postoperative incontinence, such as elderly people, multiparous women, patients with normal anal tone, patients with chronic diarrhea of any origin, and patients who had undergone previous anorectal surgery.…”

Section: Introductionmentioning

confidence: 99%

Long-term Outcome of a Fissurectomy: A Prospective Single-Arm Study of 50 Operations out of 349 Initial Patients

et al. 2018

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Purpose The surgical standard of care for patients with chronic anal fissure is still disputed. We aimed to assess the natural course of idiopathic anal fissure and the long-term outcome of a fissurectomy as a surgical treatment.Methods All consecutive patients referred to a single expert practitioner in a tertiary centre were primarily included. A fissurectomy was proposed in cases of refractory symptoms after 4 to 6 weeks of standard medical management. Only patients with idiopathic and noninfected anal fissures were included in this second subsample to undergo surgery. Conventional postoperative management was prescribed for all patients who had undergone surgery. The main outcome measures were the success rate (defined as a combination of wound healing and relief of pain) and postoperative anal continence.Results Three hundred forty-nine patients were primarily recruited. Fifty patients finally underwent surgery for an idiopathic and noninfected fissure. Among them, 47 (94%) were cured at the end of primary follow-up, and 44 of the 47 (93.6%) could be confirmed as being sustainably cured in the longer-term follow-up. The mean time of complete healing was 10.3 weeks (range, 5.7–36.4 weeks). All patients were free of pain at weeks 42. The continence score after surgery was not statistically different from the preoperative score.Conclusion A fissurectomy for the treatment of patients with an idiopathic noninfected fissure is associated with rapid pain relief and a high success rate even though complete healing may often be delayed. Moreover, it appears to have no adverse effect on continence.

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Section: Introductionmentioning

confidence: 99%

Long-term Outcome of a Fissurectomy: A Prospective Single-Arm Study of 50 Operations out of 349 Initial Patients

et al. 2018

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“…19 Again, Magdy A et al, in their study they reported cases of recurrent fissures after one year of follow up in patients who had simply V-Y anocutaneous flap to cover the fissured area without fissurectomy but in our study we implied fissurectomy as a step in both groups and we didn't experience any recurrent fissures during this follow up period. 19 Studies on AAF alone reported higher rates of unhealed fissures reaching 15-19% although, this is surprising as flaps involves implication of vascularized tissues but the fact that anal sphincter spasm and fibrosis that associates CAF may be involved and this limits the uptake of the new flap, this supports our technique that combines both and so it will decrease the incidence of non-uptake of the flap. 20,21 In this study, both groups were comparable regarding age, gender and the presenting symptoms e.g.…”

Section: Discussionmentioning

confidence: 47%

Combined mucosal advancement and lateral internal sphincterotomy in treatment of chronic anal fissure: could be an effective alternative procedure?

Elbalshy

Eldesouky

2019

Int Surg J

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Background: Chronic Anal Fissure (CAF) is a common anal problem. Lateral Internal Sphincterotomy (LIS) is the recommended treatment when conservative treatment fails, however it has its drawbacks. On the other hand, Anal Advancement Flap (AAF) may help in some cases. In this study, we tried to combine both techniques to evaluate the outcome of this dual procedure.Methods: This prospective study was conducted on one hundred patients with chronic anal ﬁssure who were divided randomly into two groups group (A) LIS, group (B) the combined technique. Both groups were compared regarding, pain and constipation prior to treatment and at 1, 2, 4, 6 weeks post-operative using Visual Analogue Scale (VAS) and Wexner constipation score at 6weeks in addition to timing of complete fissure healing.Results: Both groups were comparable preoperatively regarding demographic data, pain score, constipation score but post-operative group B has achieved an earlier significant decrease in pain score, (1.7±0.65 vs 4.4±1.1) at 1st week (P<0.001) and (1.5±0.55 vs 3.3±1.04) at 2nd week also (P<0.001). In addition to a superior healing rate (96% vs 76%) at 4th week (P=0.009) with non-significantly longer operative time or complication rate.Conclusions: The combined technique of mucosal advancement and LIS can achieve a superior outcome compared to the traditional LIS in the treatment of CAF regarding faster healing rates with marked decrease in early post- operative pain and by far earlier return to normal life habits.

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“…Techniques are mucosal advancement flaps from the rectum [ 16 , 33 , 34 ] and different techniques of anocutaneous advancement flaps from the perianal skin [ 9 – 15 , 18 , 19 ]. Most of the studies involving flaps have small patient numbers or excluded patients for different reasons [ 20 , 35 , 36 ]. In a large cohort of 1139 unselected patients operated for chronic anal fissures, AAF was performed in 80% of the patients and proved to be superior to FIS concerning postoperative symptoms and wound healing [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

Anocutaneous advancement flap provides a quicker cure than fissurectomy in surgical treatment for chronic anal fissure—a retrospective, observational study

Hancke

Suchan

Voelke

2021

Langenbecks Arch Surg

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Purpose Anocutaneous advancement flap is a surgical procedure for the treatment of chronic anal fissures. This study aimed to assess the results of anocutaneous advancement flap in a consecutive cohort of patients. Methods This is a retrospective, observational study. From 2000 to 2011, 481 patients had been operated for a single chronic anal fissure at the Maingau Clinic of the German Red Cross in Frankfurt am Main. The intention was to excise the fissure by fissurectomy (FIS) and then to cover the wound primarily with an anocutaneous advancement flap (AAF). The primary outcomes were resolution of symptoms and healing rates 1 month postoperatively. Secondary outcomes included incidences of early and late complications, postoperative incontinence, and recurrent fissure. Results Anocutaneous advancement flap was performed in 455 (94.6%). In 26 (5.4%) patients, AAF failed due to lacking skin and the wound left open after FIS. One month postoperatively, half of the patients with AAF were free of symptoms (53.2%) with complete wound healing (47.9%). The incidence of early complications within 1 month postoperatively was 0.9% after AAF. From 1 month to 5 years after operation anal abscesses and fistula occurred in 2.9%. Mild symptoms of anal incontinence were recorded in 0.2% and recurrent chronic anal fissure in 3.3% of patients. Subgroup analysis revealed improved wound healing 1 month postoperatively in patients with AAF compared to FIS. Conclusion Anocutaneous advancement flap is a very safe sphincter-sparing surgical option for CAF, provides a quicker cure than fissurectomy, and may be considered a good first-line surgical treatment option for chronic anal fissures if medical treatment failed.

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Comparative Study of Conventional Lateral Internal Sphincterotomy, V-Y Anoplasty, and Tailored Lateral Internal Sphincterotomy with V-Y Anoplasty in the Treatment of Chronic Anal Fissure

Abstract: Although all three procedures are simple and easy to perform, tailored lateral internal sphincterotomy with V-YF appears to produce the greatest healing rate, with the fewest complications and less rate of recurrence.

Cited by 36 publications

References 41 publications

Long-term Outcome of a Fissurectomy: A Prospective Single-Arm Study of 50 Operations out of 349 Initial Patients

Long-term Outcome of a Fissurectomy: A Prospective Single-Arm Study of 50 Operations out of 349 Initial Patients

Combined mucosal advancement and lateral internal sphincterotomy in treatment of chronic anal fissure: could be an effective alternative procedure?

Anocutaneous advancement flap provides a quicker cure than fissurectomy in surgical treatment for chronic anal fissure—a retrospective, observational study

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