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01.07.2005 | Original Article | Ausgabe 4/2005

International Journal of Colorectal Disease 4/2005

Early results of a rotational flap to treat chronic anal fissures

Zeitschrift:
International Journal of Colorectal Disease > Ausgabe 4/2005
Autoren:
Meheshinder Singh, Abhiram Sharma, Angela Gardiner, Graeme S. Duthie
Wichtige Hinweise
These are the results of the initial ten cases presented as a poster at the annual meeting of The Association of Coloproctology of Great Britain and Ireland, July 2003. The abstract was published in Colorectal Disease, 5 [Suppl 1]:73, July 2003. Poster presentation at the British Society of Gastroenterology meeting, Glasgow, March 2004. The abstract was published in Gut, A66 [Suppl 3:53, April 2004. Oral presentation at the Association of Surgeons of Great Britain and Ireland meeting, 28–30th April 2004. The abstract was published in Br J Surg 91(1), May 2004.

Abstract

Background

Treatment of anal fissures has changed dramatically in the past decade. Only a few fail to respond to medical therapy. Sphincterotomy and anal dilatation have fallen out of favour due to the risk of incontinence. Island flaps have been proposed to address this, but 60–70% of flap donor sites break down with complications. We proposed that using a rotational flap would overcome this problem.

Methods

Twenty-one patients (14 women,7 men) with chronic anal fissures were treated with rotation flap from perianal skin. The median age was 43 (range 21–76) years. All patients had failed chemical sphincterotomy and showed no signs of improvement following at least a 3-month course of topical GTN 0.2% ointment.

Results

The median hospital stay was 2 days. Seventeen patients had complete resolution of symptoms. Only one patient continued to have severe pain. Two developed a recurrent fissure. One patient had a combined fistula–fissure complex at diagnosis and suffered from a breakdown of the flap and donor site. Another patient had had haemorrhoidectomy and an advancement flap in the past. He developed problems with the donor site, which was successfully managed conservatively. One patient had persistent mild pain after surgery, but the cause could not be found. None of the patients suffered continence defects after surgery.

Conclusion

Use of a rotational flap is a simple, safe and successful treatment for anal fissures. Donor site problems are minimised using this approach. It should be a treatment of choice when surgery is required for chronic anal fissures, particularly in patients in whom there is a risk of incontinence.

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