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01.10.2012 | Original Article | Ausgabe 10/2012

Journal of Gastrointestinal Surgery 10/2012

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

Zeitschrift:
Journal of Gastrointestinal Surgery > Ausgabe 10/2012
Autoren:
Alaa Magdy, Ayman El Nakeeb, El Yamani Fouda, Mohamed Youssef, Mohamed Farid

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.

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