Advancement flap in the management of chronic anal fissure: A prospective study

Gaetano Giuseppe Di Vita, Giovanni Guercio, Giuseppe Livio Angelo, Paolo Salvatore Lorenzo Aiello, Rosalia Patti, Valentina Territo

Research output: Contribution to journalBook/Film/Article review

5 Citations (Scopus)

Abstract

Lateral internal sphincterotomy is the surgical treatment of choice of chronic anal fissure after failure of conservative measures. Several randomized trials identified an overall risk of incontinence of 10 % mostly for flatus. Fissurectomy is the most commonly used procedure to preserve the integrity of the anal sphincters. However, a possible complication is keyhole defect that may lead to faecal soiling. In this study, chronic anal fissure (CAF) was treated by fissurectomy and anal advancement flap to preserve the anatomo-functional integrity of sphincters and to reduce healing time and the risk of anal stenosis. In patients with hypertonia, surgical treatment was combined with chemical sphincterotomy by injection of botulinum toxin to enhance tissue perfusion. Forty eight patients with CAF underwent fissurectomy and anal advancement flap. In 22 subjects with hypertonia of the internal anal sphincter, intrasphincter injection of 30 UI of botulinum toxin at the completion of the surgical operation was used. All patients were followed up to 24 months. Since the first defecation, the intensity and duration of pain were significantly reduced. Two patients had urinary retention, five had infections and three had partial breakdowns. No anal stenosis, keyhole deformity or necrosis flap was recorded. At the 24 months follow-up visit, anal incontinence was similar to those detected preoperatively. Only four recurrences were detected at 18 and 20 months. After medical treatment failure, fissurectomy with advancement flap is a valid sphincter-conserving procedure for treatment of anterior or posterior CAF, regardless of hypertonia of the internal anal sphincter. © 2011 Springer-Verlag.
Original languageEnglish
Pages (from-to)101-106
Number of pages6
JournalUpdates in Surgery
Volume64
Publication statusPublished - 2012

Fingerprint

Fissure in Ano
Anal Canal
Prospective Studies
Botulinum Toxins
Pathologic Constriction
Flatulence
Injections
Defecation
Urinary Retention
Treatment Failure
Necrosis
Therapeutics
Perfusion
Recurrence
Pain
Infection

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Di Vita, G. G., Guercio, G., Angelo, G. L., Aiello, P. S. L., Patti, R., & Territo, V. (2012). Advancement flap in the management of chronic anal fissure: A prospective study. Updates in Surgery, 64, 101-106.

Advancement flap in the management of chronic anal fissure: A prospective study. / Di Vita, Gaetano Giuseppe; Guercio, Giovanni; Angelo, Giuseppe Livio; Aiello, Paolo Salvatore Lorenzo; Patti, Rosalia; Territo, Valentina.

In: Updates in Surgery, Vol. 64, 2012, p. 101-106.

Research output: Contribution to journalBook/Film/Article review

Di Vita, GG, Guercio, G, Angelo, GL, Aiello, PSL, Patti, R & Territo, V 2012, 'Advancement flap in the management of chronic anal fissure: A prospective study', Updates in Surgery, vol. 64, pp. 101-106.
Di Vita, Gaetano Giuseppe ; Guercio, Giovanni ; Angelo, Giuseppe Livio ; Aiello, Paolo Salvatore Lorenzo ; Patti, Rosalia ; Territo, Valentina. / Advancement flap in the management of chronic anal fissure: A prospective study. In: Updates in Surgery. 2012 ; Vol. 64. pp. 101-106.
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abstract = "Lateral internal sphincterotomy is the surgical treatment of choice of chronic anal fissure after failure of conservative measures. Several randomized trials identified an overall risk of incontinence of 10 {\%} mostly for flatus. Fissurectomy is the most commonly used procedure to preserve the integrity of the anal sphincters. However, a possible complication is keyhole defect that may lead to faecal soiling. In this study, chronic anal fissure (CAF) was treated by fissurectomy and anal advancement flap to preserve the anatomo-functional integrity of sphincters and to reduce healing time and the risk of anal stenosis. In patients with hypertonia, surgical treatment was combined with chemical sphincterotomy by injection of botulinum toxin to enhance tissue perfusion. Forty eight patients with CAF underwent fissurectomy and anal advancement flap. In 22 subjects with hypertonia of the internal anal sphincter, intrasphincter injection of 30 UI of botulinum toxin at the completion of the surgical operation was used. All patients were followed up to 24 months. Since the first defecation, the intensity and duration of pain were significantly reduced. Two patients had urinary retention, five had infections and three had partial breakdowns. No anal stenosis, keyhole deformity or necrosis flap was recorded. At the 24 months follow-up visit, anal incontinence was similar to those detected preoperatively. Only four recurrences were detected at 18 and 20 months. After medical treatment failure, fissurectomy with advancement flap is a valid sphincter-conserving procedure for treatment of anterior or posterior CAF, regardless of hypertonia of the internal anal sphincter. {\circledC} 2011 Springer-Verlag.",
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AB - Lateral internal sphincterotomy is the surgical treatment of choice of chronic anal fissure after failure of conservative measures. Several randomized trials identified an overall risk of incontinence of 10 % mostly for flatus. Fissurectomy is the most commonly used procedure to preserve the integrity of the anal sphincters. However, a possible complication is keyhole defect that may lead to faecal soiling. In this study, chronic anal fissure (CAF) was treated by fissurectomy and anal advancement flap to preserve the anatomo-functional integrity of sphincters and to reduce healing time and the risk of anal stenosis. In patients with hypertonia, surgical treatment was combined with chemical sphincterotomy by injection of botulinum toxin to enhance tissue perfusion. Forty eight patients with CAF underwent fissurectomy and anal advancement flap. In 22 subjects with hypertonia of the internal anal sphincter, intrasphincter injection of 30 UI of botulinum toxin at the completion of the surgical operation was used. All patients were followed up to 24 months. Since the first defecation, the intensity and duration of pain were significantly reduced. Two patients had urinary retention, five had infections and three had partial breakdowns. No anal stenosis, keyhole deformity or necrosis flap was recorded. At the 24 months follow-up visit, anal incontinence was similar to those detected preoperatively. Only four recurrences were detected at 18 and 20 months. After medical treatment failure, fissurectomy with advancement flap is a valid sphincter-conserving procedure for treatment of anterior or posterior CAF, regardless of hypertonia of the internal anal sphincter. © 2011 Springer-Verlag.

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