Outcomes of Fissurectomy and Advancement Flap in Management of Chronic Anal Fissure

Abstract

Chronic anal fissure is a painful linear tear in the mucocutaneous junction of the distal part of the anal canal and involves the full thickness of mucosa, causing severe pain may last even hours after defecation. Usually,it occurs along the midline either anterior or posterior,if it presents off the midline, other pathology might be associated with. Unhealed anal fissure after 6-8 weeks is defined chronic, with the presence of other criteria,it unlikely heals with medical treatment, and surgery is mandatory after pharmacological treatment failure. Lateral internal sphincterotomy had high healing rate, but unfortunately, with risk of incontinence. Fissurectomywithcomplete excision of the fissure keeping the internal anal sphincter intact,and an advancement flap of well vascularized tissue is transferred to cover the base of fissure and improve healing. This study mainly aiming to analyze the outcome of fissurectomy with advancement flap procedure in the treatment of chronic anal fissure and highlight its advantage in terms of healing rate and complications especially anal incontinence.During a period of about 5 years 345 patients (260 males and 85 females), have been included in this study and were diagnosed as cases of chronic anal fissure. After administration of local anesthetic,fissurectomywith advanced flap was performed. Patients had been followed up regularly for 6-24 months. Data collected and statistical analysesby using SPSS.About 75% of patients were males while, 25% were females, their ages were between 20-59 year, most of the patients were in thirties, nevertheless most of the females were in twenties.Mean time for wound healing was 10 days. Whilst complete fissure healing process lasting approximately one month. About 11.9% of the patients take more than one month to complete healing process. Healing rate was 100% after the follow up period of 6-24 months. Recurrence developed only in 2% of the patients. None of the patients developed incontinence, anal stenosis, key hole deformity, necrosis or urine retention. From this study concluded Fissurectomy with advancement flap in the treatment of chronic anal fissure is cost effective procedure, can be done under LA with least time-off work, with low complication, low recurrence,and no incontinence.