Top

Journal of Gastrointestinal Surgery

Published in:

01-10-2012 | Original Article

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

Authors: Alaa Magdy, Ayman El Nakeeb, El Yamani Fouda, Mohamed Youssef, Mohamed Farid

Published in: Journal of Gastrointestinal Surgery | Issue 10/2012

Abstract

Background

Lateral internal sphincterotomy has been proven highly effective in curing anal fissure but with a high incidence of postoperative incontinence.

Objective

We compared conventional lateral internal sphincterotomy, V-Y advancement flap, and combined tailored lateral internal sphincterotomy with V-Y advancement flap in treating anal fissure.

Patients

Consecutive patients treated for anal fissure at our colorectal unit were evaluated for inclusion. Participants were randomly allocated to receive conventional sphincterotomy (GI), V-Y advancement flap (GII), or combined tailored lateral sphincterotomy with V-Y advancement l flap (GIII).

Main Outcome Measures

The primary outcome measure was the incontinence rate; secondary outcomes included healing rate, operative time, anal manometery, and recurrence rate.

Results

One hundred fifty patients with chronic anal fissure were randomized. Healing rate after 1 year was 84 % in GI, 48 % in GII, and 94 % in GIII, respectively (P = 0.001). The recurrence rate was 4 % in G1, 22 % in GII, and 2 % in GIII (P = 0.01). Incontinence rate was 14 % in GI, 0 % in GII, and 2 % in GIII (P = 0.03).

Conclusion

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.

Lindsey I, Jones OM, Cunningham C, et al. Chronic anal fissure. BJS 2004, 91:270-279.CrossRef

Rakinic J. Anal fissure. Benign anorectal conditions. Clin Colon Rectal Surg 2007, 20(2):133–137

Abraham A, Ayantunde, Samuel AD. Current concept in anal fissures. World J Surg 2006; 30:2246-2260CrossRef

Notaras MJ. Lateral subcutaneous sphincterotomy for anal fissure-a new technique. Proc R Soc Med 1969, 62:713PubMed

Notaras MJ. The treatment of anal fissure by lateral subcutaneous sphincterotomy—a technique and results. Br J Surg 1971; 58:96–100PubMedCrossRef

Nelson R. Operative procedures for fissure in ano. Cochrane Database Syst Rev 2010;20(1):CD002199

Abcarian H, Lakshmahan S, Read DR, Roccaforte P. The role of internal sphincter in chronic anal fissures. Dis Colon Rectum. 1982; 25:525–528.PubMedCrossRef

Pernikoff BJ, Eisenstat TE, Rubin RJ, Oliver GC, Salvati EP. Reapprasial of partial lateral internal sphincterotomy. Dis Colon Rectum 1994, 37:1291-1295.PubMedCrossRef

Lund JN, Scholefield JH. Aetiology and treatment of anal fissure. Br J Surg 1996, 83:1335-1344.PubMedCrossRef

10.

Lewis TH, Corman MI, Prager ED, Robertson WG. Long term results of open and closed Sphincterotomy for anal fissure. Dis Colon Rectum 1988; 31:368–371.PubMedCrossRef

11.

Garcia-Aguilar J, Belmonte Montes C, Perez JJ, Jensen L, Madoff RD, Wong WD. Incontinence after lateral internal sphincterotomy: anatomical and functional evaluation. Dis Colon Rectum 1998, 41:423-427.PubMedCrossRef

12.

Hsu TC, MacKeigan JM. Surgical treatment of chronic anal fissure: a retrospective study of 1753 cases. Dis Colon Rectum 1984, 27:475-478.PubMedCrossRef

13.

Madoff RD, Fleshman JW. AGA technical review on the diagnosis and care of patients with anal fissure. Gastroenterology 2003, 124:235–245.PubMedCrossRef

14.

Littlejohn DR and Newstead GL. Tailored lateral sphincterotomy for anal fissure. Dis Colon Rectum 1997; 40:1439-42PubMedCrossRef

15.

Brisinda G,Albanese A, Cadeddu F. Botulinum neurotoxin to treat anal fissure: resultsof a randomized study Botox vs Dysport controlled trial. Aliment pharmacol Ther 2004; 19:695–701.PubMedCrossRef

16.

Brown CJ, Dubreuil D, Santoro L. Lateral internal sphincterotomy is superior to topical nitroglycerin for healing chronic anal fissure and does not compromise long term fecal continence: six-year follow up of a multicenter, randomized, controlled trial. Dis Colon Rectum 2007; 50:442-448PubMedCrossRef

17.

Habr-Gama A, Sobrado CW, de Araujo SE et al. Surgical treatment of anal stenosis: assessment of 77 anoplasties. Clinics 2005; 60:17-20PubMedCrossRef

18.

Singh M, Sharma A, Gardiner A. Early results of a rotational flap to treat chronic anal fissures. Int J Colorect Dis 2005; 20:339-342CrossRef

19.

Owen HA, Edwards DP, Khosraviani K. The house advancement anoplasty for treatment of anal disorders. J R Army Med Corps 2006; 152:87-88PubMed

20.

Samson RB, Stewart WRC. Sliding skin grafts in the treatment of anal fissures. Dis Colon Rectum 1971; 13:372-375CrossRef

21.

Nyam DC, Wilson RG, Steward KJ. Island advancement flaps in the management of anal fissures. Br J Surg 1995; 82:326-328PubMedCrossRef

22.

Kenefick NJ, Gee AJ, Durdey P. Treatment of resistant anal fissure with advancement anoplasty. Colorect Dis 2002 4:463-466CrossRef

23.

Chambers W, Sajal R, Dixon A. V-Y advancement flap as first-line treatment for all chronic anal fissures. Int J Colorectal Dis 2010 25(5):645-648.PubMedCrossRef

24.

Giordano P, Gravante G, Grondona P, Ruggiero B, Porrett T, Lunniss PJ. Simple cutaneous advancement flap anoplasty for resistant chronic anal fissure: a prospective study. World J Surg 2009; 33(5):1058-1063.PubMedCrossRef

25.

Hancke E, Rikas E, Suchan K, Volke K. Dermal flap coverage for chronic anal fissure: lower incidence of anal incontinence compared to lateral internal sphincterotomy after long-term follow-up. Dis Colon Rectum 2010; 53(11):1563-1568.PubMedCrossRef

26.

Patti R, Fama F, Tornambe A, Restivo M, Restivo M, Di VG. Early results of fissurectomy and advancement flap for resistant chronic anal fissure without hypertonia of the internal anal sphincter. Am Surg 2010; 76(2):206-210.PubMed

27.

Pescatori M, Anastasio G, Bottini C, Mentasti A. New grading and scoring for anal incontinence. Evaluation of 335 patients. Dis Colon Rectum. 1992;35:482-487.PubMedCrossRef

28.

Eypasch E, Williams JI, Wood-Dauphinee S, et al. Gastrointestinal Quality of Life Index: development, validation and application of a new instrument. Br J Surg. 1995;82:216-222.PubMedCrossRef

29.

Mentes BB, Tezcaner T, Yilmaz U, Leventoglu S, Oguz M. Results of lateral internal sphincterotomy for chronic anal fissure with particular reference to quality of life. Dis Colon Rectum. 2006;49:1045-1051.PubMedCrossRef

30.

Hananel N, Gordon PH: Lateral internal sphincterotomy for fissure-in-ano-revisited. Dis Colon Rectum 1997, 40:597-602.PubMedCrossRef

31.

Ravikumar TS, Sridhar S, Rao RN. Subcutaneous lateral internal sphincterotomy for chronic fissure-in-ano. Dis Colon Rectum 1982;25:798-801PubMedCrossRef

32.

Mazier WP. An evaluation of the surgical treatment of anal fissures. Dis Colon Rectum 1972;15:222-7.PubMedCrossRef

33.

Farouk R, Monson JR, Duthie GS. Technical failure of Lateral sphincterotomy for treatment of chronic anal fissure: a study using endoanal ultrsonography. Br J Surg 1997; 84:84-5PubMed

34.

Rudd WW .Lateral subcutaneous internal sphincterotomy for chronic anal fissure, an outpatient's procedure. Dis Colon Rectum 1975; 18:319-23PubMedCrossRef

35.

Khubchandani I, Reed J. Sequelae of internal sphincterotomy for chronic fissure-in-ano. BJS 1989; 76:431-434CrossRef

36.

Abcarian H. Surgical correction of chronic anal fissure: results of lateral internal sphincterotomy vs. fissurectomy-midline sphincterotomy. Dis Colon Rectum 1980; 23:31-36.PubMedCrossRef

37.

Blessing H. Late results after individualized lateral internal sphincterotomy [in German]. Helv Chit Acta 1993; 59:603-7.

38.

Pfeifer J, Berger A, Uranus. Surgical therapy of chronic anal fissure--do additional proctologic operations impair continence [in German]? Chirurg 1994; 65:630-3.PubMed

39.

Sultan AH, Kamm MA, Nicholls RJ, Bartram CI. Prospective study of the extent of internal anal sphincter division during lateral sphincterotomy. Dis Colon Rectum 1994; 37:1031-3.PubMedCrossRef

40.

Leong AF, Seow-Choen F. Lateral sphincterotomy compared with anal advancement flap for chronic anal fissure. Dis Colon Rectum 1995; 38(1):69-71.PubMedCrossRef

41.

Cross K, Massey E, Fowler A, Monson J. The management of anal fissure: ACPGBI position statement. Colorectal Dis 2008; 10(3):1-7.PubMedCrossRef

42.

Prohn P, Bonner C. IS manometery essential for surgery of chronic fissure in ano? Dis Colon Rectum 1995; 44:735-8CrossRef

43.

Zbar AP, Beer Gabbel M, Chiappa AC, Chiappa AC, Aslam M. Incontinence after minor anorectal surgery . Dis Colon Rectum 2001; 44:1610-23PubMedCrossRef

44.

Garcia-Aguilar J, Belmonte C, Wong WD, Lowry AC, Madoff RD. Open vs. closed sphincterotomy for chronic anal fissure: long term results. Dis Colon Rectum1996; 39:440-30PubMedCrossRef

Title: 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
Authors: Alaa Magdy
Ayman El Nakeeb
El Yamani Fouda
Mohamed Youssef
Mohamed Farid
Publication date: 01-10-2012
Publisher: Springer-Verlag
Published in: Journal of Gastrointestinal Surgery / Issue 10/2012
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-012-1984-5

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

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

Background

Objective

Patients

Main Outcome Measures

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Objective

Patients

Main Outcome Measures

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 10/2012

“Venous Cut-off Sign” as an Adjunct to the “Whirl Sign” in Recognizing Acute Small Bowel Volvulus via CT Scan

Systematic Review and Meta-analysis of the Influence of HER2 Expression and Amplification in Operable Oesophageal Cancer

Response to “Long Term Outcomes Following Surgery for Colorectal Cancers in Octogenarians: A Single Institution’s Experience of 204 Patients”

Management of Squamous Cell Cancer of the Oesophagus in a Patient with a Polyglandular Endocrinopathy (APECED) and Achalasia

Meta-analysis of the Results of Randomized Controlled Trials that Compared Laparoscopic and Open Surgery for Acute Appendicitis

Short-term Outcomes in Obese Patients after Colectomy for Adenocarcinoma at a Bariatric Center