Published in:
01-05-2010 | Original Article
V–Y advancement flap as first-line treatment for all chronic anal fissures
Published in: International Journal of Colorectal Disease | Issue 5/2010
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Introduction
It was suggested that anal advancement flap be used to treat patients with chronic anal fissures that have failed medical management and have a low-pressure sphincter complex. We wished to assess anal advancement flap as a treatment for all chronic anal fissures.
Methods
All patients with chronic anal fissures regardless of their previous management underwent V–Y advancement flap. Patient demographics, symptom duration, previous treatments, short-term postoperative outcome and long-term follow-up were recorded.
Results
Fifty-four consecutive patients, median age 39 years (22–66), underwent a V–Y advancement flap over a 7-year period; 34 were men. Duration of symptoms ranged from 2 to 36 months with a median of 8 months. Forty-two patients (78%) had failed a previous therapy: glyceryl trinitrate (GTN) (25), GTN and diltiazem (16) and lateral sphincterotomy (one). Wound dehiscence occurred in three patients of which only one required a surgical intervention. On follow-up at 6 months, all but one patient had a healed wound and was asymptomatic.
Conclusions
We have shown excellent rates of healing of chronic anal fissures treated with a V–Y advancement flap regardless of sphincter pressures, previous treatment and symptom chronicity. These results show the technique can be applied to all chronic fissures with success and used as a primary therapy.