Anal Advancement Flap versus Lateral Internal Sphenecterotomy for Treatment of Chronic Anal Fissure with High-pressure Anal Canal.

Document Type : Original Article

Authors

1 general surgery department , faculty of medicine , Zagazig university

2 Surgery department, Faculty of Medicine, Zagazige University, Zagazige, Egypt

3 Department of general surgery- Faculty of Medicine- Zagazig University.

4 department of general surgery,faculty of medicine,zagazig university

Abstract

Background: Anal fissure, is an ulcer-like, longitudinal tear in the anal canal squamous epithelium . Nowadays the standard treatment for anal fissure is Lateral internal sphincterotomy (LIS). Anal advancement flap (AAF) procedure is accomplished by transfer of healthy well-vascularized tissue onto the base of the fissure combined with fissurectomy, this improves wound healing and decrease anal stenosis risk.
Methods: Forty patients with chronic anal fissure and hypertonic anal sphincter detected by anal Manometry. Allocated randomly into two groups .Lateral internal sphincterotomy group (A) and anal advancement flap group (B) .
Objectives : the aim of this study is to compare the outcome of lateral internal sphincterotomy and anal advancement flap in management of chronic anal fissure.
Results: A total number of 40 cases (20 cases in each groups). Manometry results showed no significant difference in the preoperative mean resting anal pressure was observed among the two groups. The Mean ± SD for group A was 104.3900 ± 12.93917 and for group B was 107.3900 ± 12.30241 as shown in. the operative time in Group A ranged from 8- 12 minutes with a mean operative time 10.0 ± 1.3 minutes. In Group B, the operative time ranged from 25-41 minutes with a mean operative time 32.0 ± 6.01752 minutes. As regard hospital stay in this study, no difference was found between both groups.
Conclusions: In conclusion, anal advancement flap is a comparable procedure for LIS for treatment of chronic anal fissure in hypertonic anal canal.

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Zagazig University Medical Journal
Volume 29, Issue 2.1
March and April 2023
Pages 192-200

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