Partial reports of these data were presented at the JFHOD 2010 (25–28 March, Paris, France, oral communication), the ASCRS 2010 (15–19 May, Minneapolis, Minnesota, poster P57), the ESCP 2010 (22–25 September, Sorrento, Italy, poster 0457), and the UEGW 2010 (October 23–27, Barcelona, Spain, poster P0086).
Sphincter-sparing anal-fissure surgery: a 1-year prospective, observational, multicentre study of fissurectomy with anoplasty
Article first published online: 27 FEB 2013
© 2012 The Authors. Colorectal Disease © 2012 The Association of Coloproctology of Great Britain and Ireland
Volume 15, Issue 3, pages 359–367, March 2013
How to Cite
Abramowitz, L., Bouchard, D., Souffran, M., Devulder, F., Ganansia, R., Castinel, A., Suduca, J.-M., Soudan, D., Varastet, M., Staumont, G. and for the GREP: Groupe de Recherche En Proctologie de la Société Nationale Française de Colo-Proctologie; and the CREGG: Club de Réflexion des cabinets et Groupe d’Hépato-Gastroentérologie (2013), Sphincter-sparing anal-fissure surgery: a 1-year prospective, observational, multicentre study of fissurectomy with anoplasty. Colorectal Disease, 15: 359–367. doi: 10.1111/j.1463-1318.2012.03176.x
The Laboratories Pierre Fabre, which were not otherwise involved in the work, and ClinSearch funded part of this work.
- Issue published online: 27 FEB 2013
- Article first published online: 27 FEB 2013
- Accepted manuscript online: 7 JUL 2012 09:14AM EST
- Received 2 January 2012; accepted 2 April 2012; Accepted Article online 7 July 2012
- anal incontinence;
- anal fissure;
- quality of life
Aim Internal sphincterotomy is the standard surgical treatment for chronic anal fissure, but is frequently complicated by anal incontinence. Fissurectomy is proposed as an alternative technique to avoid sphincter injury. We describe 1-year outcomes of fissurectomy.
Method This was a prospective, multicentre, observational study. All patients with planned surgery for chronic anal fissure were included and had fissurectomy. Data were collected before surgery, at healing, and 1 year after fissurectomy. Patient self-assessed anal symptoms and quality of life (using the 36-item short-form health survey [SF-36] questionnaire). Presurgical and postsurgical variables were compared using the Wilcoxon signed-rank test for paired samples.
Results Two-hundred and sixty-four patients were included (median age, 45 years; 52% women). Anoplasty was associated with fissurectomy in 83% of the 257 documented cases. The main complications were urinary retention (n = 3), local infection (n = 4) and faecal impaction (n = 1). Healing was achieved in all patients at a median of 7.5 weeks after surgery. No recurrence occurred. At 1 year, 210 (79%) questionnaires were returned. Median anal pain had dropped from 7.3/10 to 0.1/10 (P < 0.001), anal discomfort had decreased from 5.0/10 to 0.1/10 (P < 0.001) and the Knowles–Eckersley–Scott Symptom constipation score had decreased from 9/45 to 5/45 (P < 0.001). There was a nonsignificant increase in the Wexner anal incontinence score, from 1/20 to 2/20. De-novo clinically significant anal incontinence (Wexner score > 5) affected 7% of patients at 1 year, but presurgical incontinence had disappeared in 15% of patients. All SF-36 domains significantly improved. Anoplasty did not impact any result.
Conclusion Given its high rate of healing and low rate of de-novo anal incontinence, fissurectomy with anoplasty is a valuable sphincter-sparing surgical treatment for chronic anal fissure.