M. Skoufou , J.H. Lefèvre , A. Fels , N. Fathallah , P. Benfredj , V. de Parades
{"title":"Fissurectomy with mucosal advancement flap anoplasty: The end of a dogma?","authors":"M. Skoufou , J.H. Lefèvre , A. Fels , N. Fathallah , P. Benfredj , V. de Parades","doi":"10.1016/j.jviscsurg.2023.03.003","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><p><span>The goal was to compare fissurectomy with mucosal advancement flap anoplasty to fissurectomy alone in the surgical treatment of </span>anal fissure.</p></div><div><h3>Patients and methods</h3><p>This study included patients who underwent surgery in 2019 for solitary, idiopathic, non-infected, posterior anal fissure, after failure of medical treatment. The choice to perform advancement flap anoplasty was based on surgeon preference and did not depend on the fissure itself. The main endpoint was the time to relief of pain.</p></div><div><h3>Results</h3><p>Of 599 fissurectomies performed during the study period, 226 patients (37.6% women, mean age 41.7<!--> <!-->±<!--> <!-->12.0 years old) underwent fissurectomy alone (<em>n</em> <!-->=<!--> <!-->182) or associated with advancement flap anoplasty (<em>n</em> <!-->=<!--> <!-->44). The two groups differed as to their sex ratio (33.5 vs. 54.5% women, <em>P</em> <!-->=<!--> <span>0.01), body mass index (25.3</span> <!-->±<!--> <!-->4.0 vs. 23.6<!--> <!-->±<!--> <!-->3.9, <em>P</em> <!-->=<!--> <!-->0.013) and Bristol score (3.2 vs. 3.4, <em>P</em> <!-->=<!--> <!-->0.038). Time to relief of pain, time to disappearance of bleeding and time to healing were 1.1 (0.5–2.3), 1.0 (0.5–2.1) and 2.0 (1.1–3.6) months, respectively. The rate of healing was 93.8% and the complication rate was 6.2%. The differences between the two groups for these outcomes were not statistically significant. The risk factors associated with absence of healing were age ≥ 40 years (Odds ratio (OR): 3.84; 95% CI, 1.12–17.68) and pre-surgical duration of fissure<!--> <!--><<!--> <!-->35.6 weeks (OR: 6.54; 95% CI: 1.69–43.21).</p></div><div><h3>Conclusion</h3><p>Mucosal advancement flap anoplasty does not provide any added value to fissurectomy alone.</p></div>","PeriodicalId":49271,"journal":{"name":"Journal of Visceral Surgery","volume":null,"pages":null},"PeriodicalIF":2.0000,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"1","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Visceral Surgery","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1878788623000437","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 1
Abstract
Introduction
The goal was to compare fissurectomy with mucosal advancement flap anoplasty to fissurectomy alone in the surgical treatment of anal fissure.
Patients and methods
This study included patients who underwent surgery in 2019 for solitary, idiopathic, non-infected, posterior anal fissure, after failure of medical treatment. The choice to perform advancement flap anoplasty was based on surgeon preference and did not depend on the fissure itself. The main endpoint was the time to relief of pain.
Results
Of 599 fissurectomies performed during the study period, 226 patients (37.6% women, mean age 41.7 ± 12.0 years old) underwent fissurectomy alone (n = 182) or associated with advancement flap anoplasty (n = 44). The two groups differed as to their sex ratio (33.5 vs. 54.5% women, P = 0.01), body mass index (25.3 ± 4.0 vs. 23.6 ± 3.9, P = 0.013) and Bristol score (3.2 vs. 3.4, P = 0.038). Time to relief of pain, time to disappearance of bleeding and time to healing were 1.1 (0.5–2.3), 1.0 (0.5–2.1) and 2.0 (1.1–3.6) months, respectively. The rate of healing was 93.8% and the complication rate was 6.2%. The differences between the two groups for these outcomes were not statistically significant. The risk factors associated with absence of healing were age ≥ 40 years (Odds ratio (OR): 3.84; 95% CI, 1.12–17.68) and pre-surgical duration of fissure < 35.6 weeks (OR: 6.54; 95% CI: 1.69–43.21).
Conclusion
Mucosal advancement flap anoplasty does not provide any added value to fissurectomy alone.
期刊介绍:
The Journal of Visceral Surgery (JVS) is the online-only, English version of the French Journal de Chirurgie Viscérale. The journal focuses on clinical research and continuing education, and publishes original and review articles related to general surgery, as well as press reviews of recently published major international works. High-quality illustrations of surgical techniques, images and videos serve as support for clinical evaluation and practice optimization.
JVS is indexed in the main international databases (including Medline) and is accessible worldwide through ScienceDirect and ClinicalKey.