V-Y advancement island flap for the management of low resting pressure chronic anal fissure

ABSTRACT

The majority of patients with chronic anal fissure show higher resting anal pressure than normal and responds well to sphincter weakening procedures [surgical or chemical] and lateral internal sphincterotomy is the gold standard for treatment. But there is a subset of patients that show low resting anal pressure and should be identified as application of a sphincter weakening procedure here may endanger continence. In this study patients with chronic anal fissures were subjected to careful history taking, examination, anal manometry and endoanal ultrasound Patients with resting anal pressure less than 90 cm H2O and maximum squeeze pressure less than 260 cm H[2]O and / or endoanal ultrasound showing anatomical defect in anal sphincter, provided absence of incontinence or stenosis and absence of specific pathology, were eligible for the study Thirty patients were included and were managed by V-Y advancement skin flap and were followed up for 6 months All fissures were healed without recurrence during follow up and continence was preserved. The flaps were taken in all cases without necrosis or contracture but transient wound infection occurred in 3 cases [10%].The result was described as excellent in 90% and as satisfactory in 10% of cases