Fissurectomy with or without anoplasty for chronic anal fissures is a valid alternative to lateral internal sphincterotomy: a retrospective cohort study of 475 patients.
G Gallo, A Micarelli, V De Simone, S Tierno, F Tomassini, M Goglia, A Crucitti, M La Torre
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引用次数: 0
Abstract
Background: After the failure of conservative therapy, the most effective surgical treatment for chronic anal fissures (CAFs) is lateral internal sphincterotomy. However, the choice of the procedure must be always evaluated carefully due to the risk of long-term anal continence impairment. The aim of the present study is to report the outcomes of fissurectomy with or without associated anoplasty.
Methods: This study is a single-center retrospective study including patients with CAFs in whom conservative medical and non-medical treatments failed and who underwent fissurectomy with or without anoplasty from January 2015 to June 2023. Fecal continence, pain, and complications were assessed using specific questionnaires and scores.
Results: Overall, 475 patients [280 males (58.9%)] with CAF underwent fissurectomy, with (n = 392; 82.5%) or without (n = 83; 17.5%) anoplasty. The majority of them (n = 379; 79.8%) had a posterior fissure. The mean follow-up was 49.9 months ± 26.13 months, with a minimum of 1 year, showing no intraoperative complications and a 4.2% postoperative complication rate. Missed healing occurred in 7.15% of patients at 6 months of follow-up, with higher recurrence and sphincterotomy rates in posterior fissures (p = 0.04). Cleveland Clinic Incontinence Scores were higher in patients who underwent anoplasty (p = 0.002). Interestingly, anoplasty led to a significant decrease in visual analogue scale (VAS) scores (p < 0.001), compared with those who did not undergo the procedure, with a consequent faster recovery.
Conclusion: Our study showed that fissurectomy, whether performed with or without anoplasty, was a highly effective surgical option for treating CAFs, achieving an overall success rate of 92.8% without significant impairment of continence and with a low complication rate. Further randomized prospective trials are needed to confirm this finding. Interestingly, fissurectomy with anoplasty seems to allow for better short-term outcomes in terms of postoperative pain and recovery time compared with fissurectomy alone.
期刊介绍：
Techniques in Coloproctology is an international journal fully devoted to diagnostic and operative procedures carried out in the management of colorectal diseases. Imaging, clinical physiology, laparoscopy, open abdominal surgery and proctoperineology are the main topics covered by the journal. Reviews, original articles, technical notes and short communications with many detailed illustrations render this publication indispensable for coloproctologists and related specialists. Both surgeons and gastroenterologists are represented on the distinguished Editorial Board, together with pathologists, radiologists and basic scientists from all over the world. The journal is strongly recommended to those who wish to be updated on recent developments in the field, and improve the standards of their work.
Manuscripts submitted for publication must contain a statement to the effect that all human studies have been reviewed by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in an appropriate version of the 1965 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted. Reports of animal experiments must state that the Principles of Laboratory Animal Care (NIH publication no. 86-23 revised 1985) were followed as were applicable national laws (e.g. the current version of the German Law on the Protection of Animals). The Editor-in-Chief reserves the right to reject manuscripts that do not comply with the above-mentioned requirements. Authors will be held responsible for false statements or for failure to fulfill such requirements.
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