Efficacy of posterior median anal incision with incision and drainage of the anal sinus on chronic anal fissure

Abstract

Background: To explore the efficacy of posterior median anal incision plus incision and drainage of anal sinus on chronic anal fissure (CAF), and its influence on incidence and recurrence of postoperative infection.

Methods: Altogether 130 patients with CAF treated during January 2017 and January 2021 were included and divided into a research group (RG) and control group (CG). Among them, 80 patients in the RG were treated with posterior median anal incision and expansion plus anal sinus incision and drainage, while 50 in the CG were treated with lateral internal sphincterotomy. Clinical indexes (wound healing time, recovery time of bowel sounds, intraoperative blood loss, length of stay), levels of inflammatory factors (IL-6, IL-8, CRP) before and one week after treatment, changes of psychological and emotional scores (SAS, SDS scores) before and 6 months after treatment, sleep and scores of daily activities after admission and 6 months after treatment, VAS scores at 1 day, 1 week and 2 weeks after operation, compliance, total effective rate, and incidence and recurrence rate of postoperative incision infection were compared between the groups.

Results: Compared with the CG, the wound healing time, recovery time of bowel sounds and length of stay were shorter, and intraoperative blood loss was lower in the RG; the levels of IL-6, IL-8 and CRP were lower in RG one week after treatment. Six months after treatment, the SAS, SDS and PSQI scores were lower, the ADL scores were higher, the compliance and total effective rate were higher, and the incidence and recurrence rate of postoperative incision infection were lower in the RG.

Conclusion: Posterior median anal incision plus incision drainage of the anal sinus has better efficacy on CAF, and can effectively reduce the incidence of postoperative infection and recurrence.

Keywords: Posterior median anal incision and expansion; anal sinus incision and drainage; chronic anal fissure; inflammatory factors; lateral internal sphincterotomy; quality of life.

Figure 1

Clinical indicators of two groups of patients. A. Wound healing time: The wound healing time of the RG was shorter than that of the CG (P<0.05); B. Recovery time of bowel sounds: The recovery time of bowel sounds in the RG was shorter than that of the CG (P<0.05); C. Intraoperative blood loss: The amount of intraoperative blood loss in the RG was less than that of the CG (P<0.05); D. Length of stay: The hospital stay in the RG was shorter than that of the CG (P<0.05). Note: *P<0.05.

Figure 2

VAS scores and quality of life of patients in both groups. A. VAS scores: The VAS scores of patients in both groups changed after treatment, and the scores in the RG were lower than those in the CG one day, one week, and two weeks after treatment (P<0.05); B. PSQI scores: The PSQI scores of the two groups changed after treatment, and the score of the RG 6 months after treatment was lower than those of the CG (P<0.05); C. ADL scores: After treatment, the level of ADL score in both groups changed, and the score in the RG was higher than that in the CG 6 months after treatment (P<0.05). Note: *P<0.05 compared to the control group; #P<0.05 compared to 1 week and 6 months after treatment; and ^P<0.05 compared to 2 weeks after treatment.

Figure 3

Levels of inflammatory factors in both groups A. IL-6: The levels of IL-6 in both groups changed after operation, and the research group was lower than the control group (P<0.05); B. IL-8: The levels of IL-8 in both groups changed after operation, and the research group was lower than the control group (P<0.05). C. CRP: The levels of CRP in both groups changed after operation, and the research group was lower than the control group (P<0.05). Note: *P<0.05 compared to the control group; and #P<0.05 compared to before treatment.

Figure 4

Psychological mood of patients in both groups. A. SAS score: The SAS scores of patients in both groups changed after treatment, and the score of RG was lower than that of CG (P<0.05); B. SDS score: After treatment, the SDS levels of both groups changed, and the score of RG was lower than that of CG (P<0.05). Note: *P<0.05 compared to control group; and #P<0.05 compared to before treatment.