Anoplastic in the treatment of the chronic anal fissure

Cover Page

Cite item

Full Text

Abstract

Aim. To determine the effectiveness of simple anoplastic therapy, in the treatment of patients with chronic anal fissures. Materials and methods. From January 2013 to December 2016, 56 patients with chronic anal fissure were treated, including 37 (66.1%) men and 19 (33.9%) women. The average age of the patients was 44.3±7.9 years. The duration of the disease is from 3 to 12 months. The treatment was conducted in a "one-day" hospital. The anoplasty was performed by a sliding flap according to J. Musiari (1954). To normalize the tone of the internal sphincter in the postoperative period for 6 weeks, 0.3 percent nifedipine ointment Results. The average duration of the operation was 28.9±2.8 min. The hospitalization time is 23±1.9 hours. The pain syndrome for the first time on the VAS scale was 45.3±5.03 (40-50) mm, which required an average of 26.4±4.8 (20-30) mg of Ketorolac tromethamine. By the 7th day, the pain syndrome according to the VAS scale was 27.3±5.2 (20-40) mm, which required an average consumption of 12.8±5.9 (0-30) mg of analgesic. The average period of incapacity for work was 12.8±1.8 (10-14) days. Complications developed in 5 (9.0%) patients. Retraction of the flap occurred in 3 (5.4%) and 2 (3.6%) wound suppuration occurred, which required local treatment for 6 weeks. Within a period of up to 12 months, all patients were tracked; there was no recurrence of the anal fissure. No incontinence was detected. Conclusion. Anoplasty with a flap is a simple, safe and sphincter-saving operation for the treatment of a chronic anal fissure that does not respond to conservative treatment.

About the authors

Evgenii A. Zagryadskiy

Medical Center "ON CLINIC"

Email: proctolog52@rambler.ru
D. Sci (Med.), Prof. Moscow, Russia

References

  1. Dykes S.L, Madoff R.D. Benign Anorectal: Anal Fissure. In: Wolff B.G, Fleshman J.W, Beck D.E et al., eds. The ASCRS textbook of colon and rectal surgery. NY: Springer Science and Business Media LLC, 2007; p. 178-91.
  2. Жарков Е.Е. Комплексное лечение хронической анальной трещины: Автореф. дис.. канд. мед. наук. М., 2009. [Zharkov E.E. Kompleksnoe lechenie khronicheskoi anal'noi treshchiny: Avtoref. dis.. kand. med. nauk. M., 2009 (in Russian).]
  3. Gupta P. Randomized, controlled study comparing sitz-bath and no-sitz-bath treatments in patients with acute anal fissures. ANZ J Surg 2006; 76 (8): 718-21.
  4. Шелыгин Ю.А., Подмаренкова Л.Ф., Жарков Е.Е. Возможности медикаментозной релаксации внутреннего сфинктера у больных с хронической анальной трещиной. Рос. журн. гастроэнтерологии, гепатологии, колопроктологии. 2005; 2: 87. [Shelygin Yu.A., Podmarenkova L.F., Zharkov E.E. Vozmozhnosti medikamentoznoi relaksatsii vnutrennego sfinktera u bol'nykh s khronicheskoi anal'noi treshchinoi. Ros. zhurn. gastroenterologii, gepatologii, koloproktologii. 2005; 2: 87 (in Russian).]
  5. Aivaz O, Rayhanabad J, Nguyen V et al. Botulinum toxin A with fissurectomy is a viable alternative to lateral internal sphincterotomy for chronic anal fissure. Am Surg 2009; 75: 925-8.
  6. Lindsey I, Jones O.M, Cunningham C et al. Chronic anal fissure. Br J Surg 2004; 91 (3): 270-79.
  7. Casillas S, Hull T.L, Zutshi M. Incontinence after a lateral internal sphincterotomy: are we underestimating it? Dis Colon Rectum 2005; 48 (6): 1193-9.
  8. Owen H.A, Edwards D.P, Khosraviani K et al. The house advancement anoplasty for treatment of anal disorders. JR Army Med Corps 2005; 152 (2): 87-8.
  9. Singh M, Sharma A, Gardiner A et al. Early results of a rotational flap to treat chronic anal fissures. Int J Colorect Dis 2005; 20 (4): 339-42.
  10. Musiari J.P. Estenosis de ano. Sem Méd 1954; 104: 803-4.
  11. Врублевский В.А., Милитарев Ю.М. Распространенность болезней прямой и ободочной кишок у взрослого населения Москвы. Проблемы проктологии. 1983; 4: 6-10. @@Vrublevskii V.A., Militarev Iu.M. Rasprostranennost' boleznei priamoi i obodochnoi kishok u vzroslogo naseleniia Moskvy. Problemy proktologii. 1983; 4: 6-10. (in Russian)
  12. Федоров В.Д., Дульцев Ю.В. Проктология. М.: Медицина, 1984. @@Fedorov V.D., Dul'tsev Iu.V. Proktology. Moscow: Meditsina, 1984. (in Russian)
  13. Благодарный Л.А., Полетов Н.Н., Жарков Е.Е. Патогенез анальных трещин. Колопроктология. 2007; 1 (19): 38-41. @@Blagodarnyi L.A., Poletov N.N., Zharkov E.E. Patogenez anal'nykh treshchin. Koloproktologiia. 2007; 1 (19): 38-41 (in Russian).
  14. Жарков Е.Е. Комплексное лечение хронической анальной трещины. Автореф. дис.. канд. мед. наук. М., 2009. @@Zharkov E.E. Kompleksnoe lechenie khronicheskoi anal'noi treshchiny. Avtoref. dis.. kand. med. nauk. M., 2009 (in Russian).
  15. Заремба А.А. Клиническая проктология. Рига: Звайгзне, 1978. [Zaremba A.A. Clinical proktology. Riga: Zvaigzne, 1978 (in Russian)
  16. Madalinski M, Kalinowski L. Novel options for the pharmacological treatment of chronic anal fssure-role of botulin toxin. Cur Clin Pharmacol 2009; 4: 47-2.
  17. Van Outryve M. Physiopathology of the anal fissure. Acta Chir Belg 2006; 106: 517-18.
  18. Коплатадзе А.М., Стригунова Л.В., Шмаков В.А., Алекперов Э.Э. Современные принципы лечения анальной трещины. В кн.: Актуальные вопросы колопроктологии: материалы II съезда колопроктологов России с международным участием. Уфа, 2007; с. 55. @@Koplatadze A.M., Strigunova L.V., Shmakov V.A., Alekperov E.E. Sovremennye printsipy lecheniia anal'noi treshchiny. V kn.: Aktual'nye voprosy koloproktologii: materialy II s"ezda koloproktologov Rossii s mezhdunarodnym uchastiem. Ufa, 2007; s. 55 (in Russian)
  19. Gough M.J, Lewis A. The conservative treatment of fissure-in ano. Br J Surg 1983; 70: 175-6.
  20. Zinicola R, Cracco N, Totaro A et al. A simple bowel habit score for colorectal patients. Int J Colorectal Dis 2017; 32 (1): 143-5.
  21. Рогожкина Е.А. Дифференцированный патогенетический подход к лечению хронических анальных трещин. Автореф. дис.. канд. мед. наук. Ростов-на-Дону, 2017. @@Rogozhkina E.A. Differentsirovannyi patogeneticheskii podkhod k lecheniiu khronicheskikh anal'nykh treshchin. Avtoref. dis.. kand. med. nauk. Rostov-na-Donu, 2017 (in Russian)
  22. Loder P.B, Kamm M.A, Nicholls B.J. Reversible chemical sphincterotomy by local aplication of gliceryl trinitrate. Br J Surg 1994; 81: 1386-89.
  23. Jost W.H, Schimrigk K. Use of botulinum toxin in anal fissure. Dis Colon Rectum 1993;36 (10): 974.
  24. Nelson R. Non-surgical therapy for anal fissure. Cochrane Database Syst Rev 2006; 18: CD003431.
  25. Notaras M.J. Lateral subcutaneous sphincterotomy for anal fissure-a new technique. Proc R Soc Med 1969; 62 (7): 713.
  26. Nelson R.L. Epidemiology of fecal incontinence. Gastroenterology 2004; 126: S3-S7.
  27. Pelta A.E, Davis K.G, Armstrong D.N. Subcutaneous fissurotomy: a novel procedure for chronic fissure-in-ano. review of 109 cases. Dis Colon Rectum 2007; 50 (10): 1662-67.
  28. Giordano Р, Gravante G, Grondona P et al. Simple Cutaneous Advancement Flap Anoplasty for Resistant Chronic Anal Fissure: A Prospective Study. World J Surg 2009; 33 (5): 1058-3.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) 2019 Consilium Medicum

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

Согласие на обработку персональных данных

 

Используя сайт https://journals.rcsi.science, я (далее – «Пользователь» или «Субъект персональных данных») даю согласие на обработку персональных данных на этом сайте (текст Согласия) и на обработку персональных данных с помощью сервиса «Яндекс.Метрика» (текст Согласия).