Sphincter-sparing anal-fissure surgery: a 1-year prospective, observational, multicentre study of fissurectomy with anoplasty

• Published in: Colorectal disease Vol. 15; no. 3; pp. 359 - 367
• Main Authors: Abramowitz, L., Bouchard, D., Souffran, M., Devulder, F., Ganansia, R., Castinel, A., Suduca, J.-M., Soudan, D., Varastet, M., Staumont, G.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.03.2013
• Subjects: Adolescent; Adult; Aged; Anal Canal - surgery; anal fissure; anal incontinence; anoplasty; Digestive System Surgical Procedures - methods; Fecal Incontinence - etiology; Fecal Incontinence - surgery; Female; Fissure in Ano - complications; Fissure in Ano - surgery; Fissurectomy; Follow-Up Studies; Humans; Male; Middle Aged; Prospective Studies; quality of life; Reconstructive Surgical Procedures - methods; Surveys and Questionnaires; Time Factors; Treatment Outcome; Young Adult
• ISSN: 1462-8910; 1463-1318
• DOI: 10.1111/j.1463-1318.2012.03176.x

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.