Early Results of Fissurectomy and Advancement Flap for Resistant Chronic Anal Fissure without Hypertonia of the Internal Anal Sphincter

The aim of this study was to assess the efficacy of fissurectomy with skin advancement flap in healing chronic anal fissures without hypertonia of the internal anal sphincter. Twenty-six consecutive patients who failed healing after well-practiced topical medical therapy were enrolled. Anorectal manometry was performed preoperative and 6 months postoperatively. All patients were treated with fissurectomy and advancement flap through healthy skin tissue. All patients healed completely within 30 days from operation. The intensity and the duration of pain post-defecation was reduced significantly with respect to the preoperative values starting from the first defecation. One patient suffered urinary retention, two patients suffered infections, and two partial breakdowns were recorded. At 6 months the maximum resting pressure values were similar to those were detected preoperatively. One month after surgery, anal incontinence was reported in seven patients, four of whom complained about it preoperatively. At 12 months, only three subjects reported incontinence. No patients needed reoperation and no recurrences were detected. The fissurectomy, in combination with advancement flap, is a safe sphincter-saving procedure for the treatment of chronic anal fissures without hypertonia of internal anal sphincter that fails medical conservative treatment.

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Fissurectomy and anal advancement flap for anterior chronic anal fissure without hypertonia of the internal anal sphincter in females

Colorectal Disease ◽

10.1111/j.1463-1318.2009.02068.x ◽

2009 ◽

Vol 12 (11) ◽

pp. 1127-1130 ◽

Cited By ~ 15

Author(s):

R. Patti ◽

F. Famà ◽

T. Barrera ◽

G. Migliore ◽

G. Di Vita

Keyword(s):

Anal Fissure ◽

Anal Sphincter ◽

Internal Anal Sphincter ◽

Chronic Anal Fissure ◽

Advancement Flap

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Surgical Sphincter Saving Approach and Topical Nifedipine for Chronic Anal Fissure with Hypertonic Internal Anal Sphincter

Chirurgia ◽

10.21614/chirurgia.115.5.585 ◽

2020 ◽

Vol 115 (5) ◽

pp. 585

Author(s):

Beatrice D'Orazio ◽

Carmelo Sciume ◽

Fausto Fama ◽

Sebastiano Bonventre ◽

Guido Martorana ◽

...

Keyword(s):

Anal Fissure ◽

Anal Sphincter ◽

Internal Anal Sphincter ◽

Chronic Anal Fissure ◽

Sphincter Saving

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Possibilities of medical relaxation of the internal anal sphincter for anal fissures

Ambulatornaya khirurgiya = Ambulatory Surgery (Russia) ◽

10.21518/1995-1477-2021-18-2-105-110 ◽

2021 ◽

Vol 18 (2) ◽

pp. 105-110

Author(s):

M. V. Abritsova ◽

N. R. Torchua ◽

E. M. Bogdanova ◽

M. A. Markina

Keyword(s):

Anal Sphincter ◽

Internal Anal Sphincter ◽

Anal Fissures

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Extent of division of the internal anal sphincter in chronic anal fissure

Menoufia Medical Journal ◽

10.4103/1110-2098.198712 ◽

2016 ◽

Vol 29 (3) ◽

pp. 570

Author(s):

AhmedS Goda ◽

SamirM. H. Kohla ◽

Ahmed Fawzy

Keyword(s):

Anal Fissure ◽

Anal Sphincter ◽

Internal Anal Sphincter ◽

Chronic Anal Fissure

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Myoxinol (HydrolyzedHibiscus esculentusExtract) in the Cure of Chronic Anal Fissure: Early Clinical and Functional Outcomes

Gastroenterology Research and Practice ◽

10.1155/2015/567920 ◽

2015 ◽

Vol 2015 ◽

pp. 1-4 ◽

Cited By ~ 3

Author(s):

Adolfo Renzi ◽

Antonio Brillantino ◽

Giandomenico Di Sarno ◽

Francesco D’Aniello ◽

Stefania Ziccardi ◽

...

Keyword(s):

Anal Fissure ◽

Topical Application ◽

Chronic Anal Fissure ◽

Early Results ◽

Local Product ◽

Resting Pressure ◽

Hibiscus Esculentus ◽

Anal Resting Pressure ◽

Lost To Follow Up

Objective.This study was designed to evaluate the early results of the topical application of HydrolyzedHibiscus esculentusExtract 3% ointment (Myoxinol 3%), a novel local product with Botox-like activity, in the conservative treatment of chronic anal fissure (CAF).Methods.Among all patients with CAF observed during the study period, 31 subjects met the inclusion criteria and underwent medical therapy with Myoxinol 3% ointment every 12 hours for 6 weeks. Two patients were lost to follow-up. Clinical and manometric follow-up was carried out eight weeks after treatment.Results.At follow-up the success rate was 72.4% (21/29); median VAS score and mean anal resting pressure were significantly lower if compared with respective baseline data. The only one adverse effect of the topical application of Myoxinol 3% ointment was perianal itch, which was reported by 3,4% (1/29) of the patients available for the analysis. However, in this case this symptom did not cause interruption of the treatment.Conclusions.The topical application of Myoxinol 3% ointment in the cure of CAF shows encouraging early results. Further researches with a larger series and a longer follow-up are needed to confirm these data.

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Endosonographic and manometric evaluation of internal anal sphincter in patients with chronic anal fissure and its correlation with clinical outcome after topical glyceryl trinitrate therapy

International Journal of Colorectal Disease ◽

10.1007/s00384-006-0251-1 ◽

2007 ◽

Vol 22 (8) ◽

pp. 963-967 ◽

Cited By ~ 14

Author(s):

Marta Pascual ◽

Miguel Pera ◽

Ricard Courtier ◽

Mariá José Gil ◽

David Parés ◽

...

Keyword(s):

Clinical Outcome ◽

Glyceryl Trinitrate ◽

Anal Fissure ◽

Anal Sphincter ◽

Internal Anal Sphincter ◽

Chronic Anal Fissure ◽

Topical Glyceryl Trinitrate

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Utility of Ultrasound in the Evaluation of Chronic Anal Fissure

Surgical Case Reports ◽

10.31487/j.scr.2020.11.01 ◽

2020 ◽

pp. 1-4

Author(s):

Ashraf Talaat Youssef ◽

Ashraf Talaat Youssef

Keyword(s):

Anal Fissure ◽

Anal Sphincter ◽

Internal Anal Sphincter ◽

Chronic Anal Fissure ◽

Transvaginal Ultrasound ◽

Clinical History ◽

Dentate Line ◽

Chemical Sphincterotomy ◽

Healing Response ◽

Asymptomatic Patients

Introduction: Anal fissure is a linear tear in the anal mucosa seen distal to the dentate line. The diagnosis of chronic anal fissure depends on clinical history, physical exam, anoscopy and other imaging modalities are uncommonly recommended unless an associated condition was suspected. Management is either by chemical sphincterotomy or surgery through lateral internal sphincterotomy when chronic anal fissure was resistant to treatment. Purpose of the Study: The current study aimed to evaluate the sonographic findings that can be observed in cases with chronic anal fissure and their significance. Methodology: 15 asymptomatic patients and 30 patients with chronic anal fissure were examined with 3 dimensional transperineal ultrasound and if females an additional transvaginal ultrasound was performed. Results: 26 patients (86.5%) showed diffusely thickened internal anal sphincter of mean thickness >3.5mm, ranging from 3.7 mm to 6.4mm and the mean value was 5mm. 3 patients (10%) with posterior fissure showed a lucent narrow defect in the internal anal sphincter at the midline of the distal aspect of the anal canal wall. One of them showed associated localized intersphincteric plane sepsis. Conclusion: Use of ultrasound in cases with chronic anal fissure may show gapping of the internal anal sphincter and an associated intersphincteric plane sepsis corresponding to the high morphological grade of anal fissure which predict poor healing response to chemical sphincterotomy and further studies that correlate between the thickness and texture of IAS and the healing response to chemical sphincterotomy recommended.

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Manometric Evaluation of Internal Anal Sphincter after Fissurectomy and Anoplasty for Chronic Anal Fissure: A Prospective Study

The American Surgeon ◽

10.1177/000313481207800531 ◽

2012 ◽

Vol 78 (5) ◽

pp. 523-527 ◽

Cited By ~ 1

Author(s):

Rosalia Patti ◽

Valentina Territo ◽

Paolo Aiello ◽

Giuseppe Livio Angelo ◽

Gaetano Di Vita

Keyword(s):

Postoperative Complications ◽

Anal Fissure ◽

Anal Sphincter ◽

Anal Incontinence ◽

Internal Anal Sphincter ◽

Healthy Subjects ◽

Chronic Anal Fissure ◽

Skin Flap ◽

Anal Continence ◽

Squeeze Pressure

Chronic anal fissure (CAF) is a common painful clinical disease and its pathogenesis remains poorly understood. After failure of pharmacological therapy, that is the first-line treatment, surgical sphincterotomy remains the treatment of choice although it is followed by a high rate of anal incontinence resulting from the sphincter damage; therefore, the research of a sphincter-saving surgical option has become an important goal. The aim of this study was to evaluate the manometric modifications and the incidence of anal incontinence after fissurectomy and anoplasty with advancement skin flap in patients affected by CAF with hypertonia of the internal anal sphincter (IAS). Fifteen patients affected by CAF with hypertonia of IAS, unresponsive to medical therapy, were enrolled. All subjects underwent fissurectomy and anoplasty with advancement skin flap. Anorectal manometry was performed preoperatively and after 6 and 12 months from surgery. Maximum resting pressure (MRP), maximum squeeze pressure (MSP), ultraslow wave activity (USWA), fissure healing, anal continence, and postoperative complications were recorded. All patients healed within 30 days from surgery. No intra- or postoperative complications were recorded except for a case of partial donor site break. No significant modifications of MSP were detected. Six months after surgery, MRP was higher with respect to healthy subjects but significantly reduced in comparison to baseline levels. At 12 months, it was higher have versus 6-month values but significantly lower versus preoperative values. USWA was significantly represented in patients with CAF versus healthy subject. Both at 6 and 12 months, they decreased significantly with respect to preoperative values without significant differences versus healthy subjects. Both at 6 and 12 months, anal continence did not differ with respect to preoperative time. The fissurectomy with anoplasty resulted in a high healing rate without surgical sequelae or anal incontinence. Also, it was able to reduce IAS pressure in the same manner as surgical sphincterotomy or forceful dilatation.

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