Evaluation of outcomes in fissurectomy and V-Y advancement flap for the treatment of chronic anal fissure / Avaliação de desfechos na fissurectomia e retalho de avanço em V­Y para o tratamento de fissura anal crônica

ABSTRACT Chronic anal fissure is difficult to treat. Surgery is usually recommended in the case of drug therapeutic failure. Fecal incontinence in patients with weaker sphincters (multipara older patients with a history of pelvic surgery etc.) is a major reason for rejecting surgery. Such these patients should be underwent fissurectomy and V-Y advancement flap in which sphincterotomy is not required. In this prospective study, we determined the outcomes and complications of fissurectomy and V-Y advancement flap in both groups of patients with low and high anal sphincter tones.

RESUMO A fissura anal crônica tem tratamento difícil. A cirurgia geralmente é recomendada em caso de falha do tratamento medicamentoso. A incontinência fecal em pacientes com esfíncteres mais fracos (pacientes multíparas mais velhas com história de cirurgia pélvica etc.) é uma razão importante para a rejeição da cirurgia. Esses pacientes devem ser submetidos a fissurectomia e retalho de avanço em V-Y no qual a esfincterotomia não é necessária. Neste estudo prospectivo, determinamos os desfechos e complicações da fissurectomia e o retalho de avanço em V-Y em ambos os grupos de pacientes com tônus baixo e alto do esfíncter anal.

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

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.