Iranian Journal of Colorectal Research

Iranian Journal of Colorectal Research

Lateral Internal Sphincterotomy versus V-Y Anoplasty in Treatment of Chronic Anal Fissure: a Comparative Trial Based on Manometry Results

Document Type : Research/Original Article

Authors
Marwa Sobhi 1
Sameh Hany Emile 2
Ahmed AbdelMawla 1
Mohamed Youssef 1
Sabry Ahmed Mahmoud 1
1 Faculty of Medicine Mansoura University,
2 Department of General Surgery, Faculty of Medicine, Mansoura University Hospitals, Mansoura, Egypt
Abstract
Abstract
Background: Conservative treatment of chronic anal fissure (CAF) is the first line of treatment. Patients who fail conservative treatment are offered surgical treatment in the form of lateral internal sphincterotomy (LIS) or V-Y anoplasty.
Objective: This prospective study aimed to compare LIS and V-Y anoplasty in the treatment of CAF based on the baseline resting anal pressure of patients.
Methods: Female patients with CAF were investigated with anal manometry. Patients with elevated resting anal pressure were treated with LIS and patients with normal or low resting anal pressure were treated with V-Y anoplasty. Data about healing of anal fissure, reduction in pain score, continence disturbance, and complications were recorded on follow-up.
Results: Twenty-four female patients of a mean age of 37.6 years were included to this study. Sixteen patients underwent LIS (group I) and 8 underwent V-Y flap (group II). Both groups achieved comparable time to complete healing. Both groups showed significant decrease in pain score at 3 months of follow-up (Group I: 6.1±0.85 to 0.93±0.7, p
Keywords
Chronic anal fissure
Lateral internal sphincterotomy
V-Y
Anoplasty
Manometry
  1. Collins EE1, Lund JN. A review of chronic anal fissure management. Tech Coloproctol. 2007 Sep;11(3):209-23.
  2. Schlichtemeier S, Engel A. Anal fissure. Aust Prescr. 2016 Feb;39(1):14-7. doi: 10.18773/austprescr.2016.007.
  3. Nzimbala MJ, Bruyninx L, Pans A, Martin P, Herman F. Chronic anal fissure: common aetiopathogenesis, with special attention to sexual abuse. Acta Chir Belg. 2009 Nov-Dec. 109 (6):720-6.
  4. Utzig MJ1, Kroesen AJ, Buhr HJ. Concepts in pathogenesis and treatment of chronic anal fissure--a review of the literature. Am J Gastroenterol. 2003 May;98(5):968-74.
  5. Emile SH, Elgendy H, Elfeki H, Magdy A, Abdelmawla AA, Abdelnaby M, Khafagy W. Does the duration of symptoms of anal fissure impact its response to conservative treatment? A prospective cohort study. Int J Surg. 2017 Aug;44:64-70. doi: 10.1016/j.ijsu.2017.06.044
  6. Nelson RL, Manuel D, Gumienny C, Spencer B, Patel K, Schmitt K, Castillo D, Bravo A, Yeboah-Sampong A. A systematic review and meta-analysis of the treatment of anal fissure. Tech Coloproctol. 2017 Aug;21(8):605-625. doi: 10.1007/s10151-017-1664-2
  7. Emile SH. Indications and Technical Aspects of Internal Anal Sphincterotomy: Highlighting the Controversies. Dis Colon Rectum. 2017 Jan;60(1):128-132.
  8. Jorge JM, Wexner SD. Etiology and management of fecal incontinence. Dis Colon Rectum. 1993;36:77–97.
  9. Magdy A, El Nakeeb A, Fouda el Y, Youssef M, Farid M. 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. J Gastrointest Surg. 2012 Oct;16(10):1955-62. Epub 2012 Aug 7.
  10. Schouten WR1, Briel JW, Auwerda JJ. Relationship between anal pressure and anodermal blood flow. The vascular pathogenesis of anal fissures. Dis Colon Rectum. 1994 Jul;37(7):664-9.
  11. Memon AS, Siddiqui FG, Hamad A. Fissurectomy with posterior midline sphincterotomy for management of chronic anal fissure. J Coll Physicians Surg Pak. 2010 Apr;20(4):229-31. doi: 04.2010/JCPSP.229231.
  12. Nelson R. Operative procedures for fissure in ano. Cochrane Database Syst Rev. 2005 Apr 18;(2):CD002199. Review
  13. Garg P1, Garg M, Menon GR. Long-term continence disturbance after lateral internal sphincterotomy for chronic anal fissure: a systematic review and meta-analysis. Colorectal Dis. 2013 Mar;15(3):e104-17. doi: 10.1111/codi.12108.
  14. Hancke E1, Rikas E, Suchan K, Völke K. 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. 2010 Nov;53(11):1563-8. doi: 10.1007/DCR.0b013e3181f0869f.
  15. Patel SD1, Oxenham T, Praveen BV. Medium-term results of anal advancement flap compared with lateral sphincterotomy for the treatment of anal fissure. Int J Colorectal Dis. 2011 Sep;26(9):1211-4. doi: 10.1007/s00384-011-1234-4. Epub 2011 May 12.
  16. Cross KL1, Massey EJ, Fowler AL, Monson JR; ACPGBI. The management of anal fissure: ACPGBI position statement. Colorectal Dis. 2008 Nov;10 Suppl 3:1-7. doi: 10.1111/j.1463-1318.2008.01681.x.
  17. Chambers W1, Sajal R, Dixon A. V-Y advancement flap as first-line treatment for all chronic anal fissures. Int J Colorectal Dis. 2010 May;25(5):645-8. doi: 10.1007/s00384-010-0881-1. Epub 2010 Feb 23.
Iranian Journal of Colorectal Research
Volume 7, Issue 3
September 2019
Pages 1-6