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. 2021 Nov 3;92(5):e2021176.
doi: 10.23750/abm.v92i5.11200.

Fissurectomy and anoplasty in posterior normotensive chronic anal fissure

Beatrice D'Orazio  1 , Bianca Cudia  2 , Sebastiano Bonventre  3 , Fausto Famà  4 , Carmelo Sciumé  5 , Bianca Cudia  2 , Dario Calì  6 , Giovanni Corbo  7 , Gaetano Di Vita  8 , Girolamo Geraci  9
Affiliations

Fissurectomy and anoplasty in posterior normotensive chronic anal fissure

Beatrice D'Orazio et al. Acta Biomed. .

Abstract

Purpose: Anal Fissure (AF) is the second most frequent proctological disease in Italy. Chronic AF (CAF) most common located at the posterior anal commissure (CAPF). CAPF are thought to be associated with hypertonic internal anal sphincter (IAS) but manometric findings showed that a normotonic IAS is present in the 20-40%. Sphincterotomy is often recommended as treatment of choice for CAF independently from IAS tone; nevertheless, this approach appears less logical for CAF with normotonic IAS, as in those cases there's a higher risk of post-operative anal incontinence. The aim of this study is to evaluate the results of fissurectomy and anoplasty with V-Y cutaneous advancement flap, as treatment for patients suffering from CAPF without hypertonic IAS.

Methods: We enrolled 30 patients affected by CAPF without IAS hypertonia. All patients were followed up for 2 years after the surgical procedure, with evaluation of anal continence, recurrence rate and maximum resting pressure, maximum squeeze pressure, ultraslow wave activity.

Results: All patients healed within 40 days after surgery. We didn't observe any "de novo" post-operative anal incontinence cases. We reported 2 cases of recurrences, within 18 months from surgery, all healed after conservative therapy. We didn't record statistically significant differences in pre- and post-operative manometry findings.

Conclusion: At 2 years after the surgical procedure we achieved good results, these evidences shows that sphincter preserving procedures are more suitable for CAPF without hypertonic IAS.

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Conflict of interest statement

Each author declares that he or she has no commercial associations (e.g. consultancies, stock ownership, equity interest, patent/licensing arrangement etc.) that might pose a conflict of interest in connection with the submitted article.

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