BACKGROUND:Lateral internal sphincterotomy has been proven highly effective in curing anal fissure but with a high incidence of postoperative incontinence. OBJECTIVE: We compared conventional lateral internal sphincterotomy, V-Y advancement flap, and combined tailored lateral internal sphincterotomy with V-Y advancement flap in treating anal fissure. PATIENTS: Consecutive patients treated for anal fissure at our colorectal unit were evaluated for inclusion. Participants were randomly allocated to receive conventional sphincterotomy (GI), V-Y advancement flap (GII), or combined tailored lateral sphincterotomy with V-Y advancement l flap (GIII). MAIN OUTCOME MEASURES: The primary outcome measure was the incontinence rate; secondary outcomes included healing rate, operative time, anal manometery, and recurrence rate. RESULTS:One hundred fifty patients with chronic anal fissure were randomized. Healing rate after 1 year was 84% in GI, 48% in GII, and 94% in GIII, respectively (P = 0.001). The recurrence rate was 4% in G1, 22% in GII, and 2% in GIII (P = 0.01). Incontinence rate was 14% in GI, 0% in GII, and 2% in GIII (P = 0.03). CONCLUSION: Although all three procedures are simple and easy to perform, tailored lateral internal sphincterotomy with V-YF appears to produce the greatest healing rate, with the fewest complications and less rate of recurrence.
RCT Entities:
BACKGROUND: Lateral internal sphincterotomy has been proven highly effective in curing anal fissure but with a high incidence of postoperative incontinence. OBJECTIVE: We compared conventional lateral internal sphincterotomy, V-Y advancement flap, and combined tailored lateral internal sphincterotomy with V-Y advancement flap in treating anal fissure. PATIENTS: Consecutive patients treated for anal fissure at our colorectal unit were evaluated for inclusion. Participants were randomly allocated to receive conventional sphincterotomy (GI), V-Y advancement flap (GII), or combined tailored lateral sphincterotomy with V-Y advancement l flap (GIII). MAIN OUTCOME MEASURES: The primary outcome measure was the incontinence rate; secondary outcomes included healing rate, operative time, anal manometery, and recurrence rate. RESULTS: One hundred fifty patients with chronic anal fissure were randomized. Healing rate after 1 year was 84% in GI, 48% in GII, and 94% in GIII, respectively (P = 0.001). The recurrence rate was 4% in G1, 22% in GII, and 2% in GIII (P = 0.01). Incontinence rate was 14% in GI, 0% in GII, and 2% in GIII (P = 0.03). CONCLUSION: Although all three procedures are simple and easy to perform, tailored lateral internal sphincterotomy with V-YF appears to produce the greatest healing rate, with the fewest complications and less rate of recurrence.
Authors: R L Nelson; D Manuel; C Gumienny; B Spencer; K Patel; K Schmitt; D Castillo; A Bravo; A Yeboah-Sampong Journal: Tech Coloproctol Date: 2017-08-09 Impact factor: 3.781
Authors: Sabrina Maria Ebinger; Julia Hardt; René Warschkow; Bruno Martin Schmied; Alexander Herold; Stefan Post; Lukas Marti Journal: J Gastroenterol Date: 2017-04-10 Impact factor: 7.527
Authors: Adil E Bharucha; Charles H Knowles; Isabelle Mack; Allison Malcolm; Nicholas Oblizajek; Satish Rao; S Mark Scott; Andrea Shin; Paul Enck Journal: Nat Rev Dis Primers Date: 2022-08-10 Impact factor: 65.038
Authors: Jean-David Zeitoun; Pierre Blanchard; Nadia Fathallah; Paul Benfredj; Nicolas Lemarchand; Vincent de Parades Journal: Ann Coloproctol Date: 2018-04-30