Abstract
Introduction
Anal fissure is associated with anal pain and bleeding. Lateral internal sphincterotomy (LIS) has been a common form of surgical management. This can however cause incontinence and hence an equally effective alternative without this risk would be ideal. Anal fissurectomy and an anal advancement flap (AAF) have been used as an alternative to LIS.
Methods
We carried out a retrospective analysis of the results of AAF and LIS for the treatment of anal fissure. Fifty patients underwent AAF and a further 50 cases were chosen who had undergone LIS over the same time period. Patient and procedural data were collected including post-operative course.
Results
Presenting symptoms included anal pain (94%), rectal bleeding (77%) and constipation (15%). Mean (±SD) follow-up was 20 ± 12 months in the AAF group vs 22 ± 12.5 months in the LIS group. Healing of fissure was achieved in 96% of patients after AAF and 88% after LIS (p = 0.27). Resolution of symptoms was achieved in 90% after AAF and 72% of patients after LIS (p = 0.04). LIS was associated with an increased incidence of readmission with infection and pain (8% vs 4%, p = 0.35). Seven patients whom had undergone successful AAF with complete resolution of symptoms had previously had LIS with failure of symptom relief. There was no incidence of faecal incontinence in either group.
Conclusion
AAF is associated with a higher incidence of symptomatic relief and fissure healing and lower incidence of complications when compared with LIS. AAF is effective at healing fissures which are refractory to LIS.
Similar content being viewed by others
References
Schouten WR, Briel JW, Auwerda JJ, De Graaf EJ (1996) Ischaemic nature of anal fissure. Br J Surg 83(1):63–65
Bielecki K, Kolodziejczak M (2003) A prospective randomized trial of diltiazem and glyceryltrinitrate ointment in the treatment of chronic anal fissure. Colorectal Dis 5(3):256–257
Carapeti EA, Kamm MA, Phillips RK (2000) Topical diltiazem and bethanechol decrease anal sphincter pressure and heal anal fissures without side effects. Dis Colon Rectum 43(10):1359–1362
Knight JS, Birks M, Farouk R (2001) Topical diltiazem ointment in the treatment of chronic anal fissure. Br J Surg 88(4):553–556
Nelson R (2005) Operative procedures for fissure in ano. Cochrane Database Syst Rev (2):CD002199
Khubchandani IT, Reed JF (1989) Sequelae of internal sphincterotomy for chronic fissure in ano. Br J Surg 76(5):431–434
Leong AF, Seow-Choen F (1995) Lateral sphincterotomy compared with anal advancement flap for chronic anal fissure. Dis Colon Rectum 38(1):69–71
Nyam DC, Wilson RG, Stewart KJ, Farouk R, Bartolo DC (1995) Island advancement flaps in the management of anal fissures. Br J Surg 82(3):326–328
Singh M, Sharma A, Duthie G, Balasingh D, Kandasamy P (2005) Early results of a rotation flap to treat chronic anal fissures. Asian J Surg 28(3):189–191
Ouaissi M, Giger U, Sielezneff I, Yawovi KA, Pamela A, Pirro N et al (2011) Mucosal advancement flap anoplasty for chronic anal fissure resistant to conservative therapy. World J Surg 35(4):900–904
Chambers W, Sajal R, Dixon A (2010) V-Y advancement flap as first-line treatment for all chronic anal fissures. Int J Colorectal Dis 25(5):645–648
Giordano P, Gravante G, Grondona P, Ruggiero B, Porrett T, Lunniss PJ (2009) Simple cutaneous advancement flap anoplasty for resistant chronic anal fissure: a prospective study. World J Surg 33(5):1058–1063
Hancke E, Rikas E, Suchan K, Volke K (2010) Dermal flap coverage for chronic anal fissure: lower incidence of anal incontinence compared to lateral internal sphincterotomy after long-term follow-up. Dis Colon Rectum 53(11):1563–1568
Patti R, Fama F, Tornambe A, Restivo M, Di VG (2010) Early results of fissurectomy and advancement flap for resistant chronic anal fissure without hypertonia of the internal anal sphincter. Am Surg 76(2):206–210
Engel AF, Eijsbouts QA, Balk AG (2002) Fissurectomy and isosorbide dinitrate for chronic fissure in ano not responding to conservative treatment. Br J Surg 89(1):79–83
Arroyo A, Perez F, Serrano P, Candela F, Lacueva J, Calpena R (2005) Surgical versus chemical (botulinum toxin) sphincterotomy for chronic anal fissure: long-term results of a prospective randomized clinical and manometric study. Am J Surg 189(4):429–434
Minguez M, Herreros B, Espi A, Garcia-Granero E, Sanchiz V, Mora F et al (2002) Long-term follow-up (42 months) of chronic anal fissure after healing with botulinum toxin. Gastroenterology 123(1):112–117
Conflict of interest statement
The authors declare that they have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Patel, S.D., Oxenham, T. & Praveen, B.V. Medium-term results of anal advancement flap compared with lateral sphincterotomy for the treatment of anal fissure. Int J Colorectal Dis 26, 1211–1214 (2011). https://doi.org/10.1007/s00384-011-1234-4
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00384-011-1234-4