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Erschienen 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
Erschienen in: Journal of Gastrointestinal Surgery | Ausgabe 10/2012
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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.