Annals of Coloproctology

Original Article

Long-term Outcome of a Fissurectomy: A Prospective Single-Arm Study of 50 Operations out of 349 Initial Patients: Jean-David Zeitoun, Pierre Blanchard, Nadia Fathallah, Paul Benfredj, Nicolas Lemarchand, Vincent de Parades; Ann Coloproctol. 2018;34(2):83-87. Published online April 30, 2018; DOI: https://doi.org/10.3393/ac.2017.06.12

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Purpose
The surgical standard of care for patients with chronic anal fissure is still disputed. We aimed to assess the natural course of idiopathic anal fissure and the long-term outcome of a fissurectomy as a surgical treatment.
Methods
All consecutive patients referred to a single expert practitioner in a tertiary centre were primarily included. A fissurectomy was proposed in cases of refractory symptoms after 4 to 6 weeks of standard medical management. Only patients with idiopathic and noninfected anal fissures were included in this second subsample to undergo surgery. Conventional postoperative management was prescribed for all patients who had undergone surgery. The main outcome measures were the success rate (defined as a combination of wound healing and relief of pain) and postoperative anal continence.
Results
Three hundred forty-nine patients were primarily recruited. Fifty patients finally underwent surgery for an idiopathic and noninfected fissure. Among them, 47 (94%) were cured at the end of primary follow-up, and 44 of the 47 (93.6%) could be confirmed as being sustainably cured in the longer-term follow-up. The mean time of complete healing was 10.3 weeks (range, 5.7–36.4 weeks). All patients were free of pain at weeks 42. The continence score after surgery was not statistically different from the preoperative score.
Conclusion
A fissurectomy for the treatment of patients with an idiopathic noninfected fissure is associated with rapid pain relief and a high success rate even though complete healing may often be delayed. Moreover, it appears to have no adverse effect on continence.

Citations

Citations to this article as recorded by

Belgian consensus guideline on the management of anal fissures
P Roelandt, G Bislenghi, G Coremans, D De Looze, M.A. Denis, H De Schepper, P Dewint, J Geldof, I Gijsen, N Komen, H Ruymbeke, J Stijns, M Surmont, D Van de Putte, S Van den Broeck, B Van Geluwe, J Wyndaele
Acta Gastro Enterologica Belgica.2024; 87(2): 304. CrossRef
Use of Botulinum Toxin Injections for the Treatment of Chronic Anal Fissure: Results From an American Society of Colon and Rectal Surgeons Survey
Daniel J. Borsuk, Adam Studniarek, John J. Park, Slawomir J. Marecik, Anders Mellgren, Kunal Kochar
The American Surgeon™.2023; 89(3): 346. CrossRef
New Findings at the Internal Anal Sphincter on Cadaveric Dissection and Review of Sphincter-Related Surgery in a Newer Prospective
Aswini Kumar Pujahari
Indian Journal of Surgery.2023; 85(3): 585. CrossRef
Pelvic floor physical therapy in patients with chronic anal fissure: long-term follow-up of a randomized controlled trial
Daniëlle A. van Reijn-Baggen, Henk W. Elzevier, H. Putter, Rob C. M. Pelger, Ingrid J. M. Han-Geurts
International Journal of Colorectal Disease.2023;[Epub] CrossRef
Fissurectomy with mucosal advancement flap anoplasty: The end of a dogma?
M. Skoufou, J.H. Lefèvre, A. Fels, N. Fathallah, P. Benfredj, V. de Parades
Journal of Visceral Surgery.2023; 160(5): 330. CrossRef
Fissurectomy versus lateral internal sphincterotomy in the treatment of chronic anal fissures: no advantages in terms of post-operative incontinence
Roberta Tutino, Casimiro Nigro, Flavia Paternostro, Rosa Federico, Giacomo Lo Secco, Gaetano Gallo, Mauro Santarelli, Gianfranco Cocorullo, Sebastiano Bonventre
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Antonio Brillantino, Adolfo Renzi, Pasquale Talento, Francesca Iacobellis, Luigi Brusciano, Luigi Monaco, Domenico Izzo, Alfredo Giordano, Michele Pinto, Corrado Fantini, Marcello Gasparrini, Michele Schiano Di Visconte, Francesca Milazzo, Giovanni Ferrer
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La fissurectomie avec anoplastie muqueuse : la fin d’un dogme ?
Maria Skoufou, Jérémie H. Lefèvre, Audrey Fels, Nadia Fathallah, Paul Benfredj, Vincent de Parades
Journal de Chirurgie Viscérale.2023; 160(5): 363. CrossRef
Modified open posterior internal sphincterotomy with sliding skin graft for chronic anal fissure and anal stenosis: Low recurrence rate and no serious faecal incontinence postoperative complication
Y. Iida, K. Honda, R. Iida, H. Saitou, Y. Munemoto, A. Tanaka, H. Tanaka
Journal of Visceral Surgery.2022; 159(4): 267. CrossRef
Sphinctérotomie interne postérieure modifiée avec un lambeau cutané pour fissure anale et sténose anale : peu de récidives et d’incontinence anale
Y. Iida, K. Honda, R. Iida, H. Saitou, Y. Munemoto, A. Tanaka, H. Tanaka
Journal de Chirurgie Viscérale.2022; 159(4): 283. CrossRef
Injection of botulinum toxin significantly increases efficiency of fissurectomy in the treatment of chronic anal fissures
Philip Roelandt, Georges Coremans, Jan Wyndaele
International Journal of Colorectal Disease.2022; 37(2): 309. CrossRef
Clinical Trial Combining Botulinum Toxin A Injection and Fissurectomy for Chronic Anal Fissure: A Dose-Dependent Study
Nuha Alsaleh, Abdullah I. Aljunaydil, Gaida A. Aljamili
Journal of Coloproctology.2022; 42(02): 167. CrossRef
Fisurectomy and anoplasty with botulinum toxin injection in patients with chronic anal posterior fissure with hypertonia: a long-term evaluation
Beatrice D’Orazio, Girolamo Geraci, Guido Martorana, Carmelo Sciumé, Giovanni Corbo, Gaetano Di Vita
Updates in Surgery.2021; 73(4): 1575. CrossRef
The comparison between the medical and the surgical management of chronic anal fissures
Navneet Mishra, Kamal Kishore Parmar, Tanweerul Huda
Journal of Clinical and Investigative Surgery.2021; 6(1): 11. CrossRef
Anocutaneous advancement flap provides a quicker cure than fissurectomy in surgical treatment for chronic anal fissure—a retrospective, observational study
Edgar Hancke, Katrin Suchan, Knut Voelke
Langenbeck's Archives of Surgery.2021; 406(8): 2861. CrossRef
Fissurectomy Versus Lateral Internal Sphincterotomy in the Treatment of Chronic Anal Fissure: A Randomized Control Trial
Bipin Kishore Bara, Sujit Kumar Mohanty, Satya Narayan Behera, Ashok Kumar Sahoo, Santanu Kumar Swain
Cureus.2021;[Epub] CrossRef
Botulinum toxin associated with fissurectomy and anoplasty for hypertonic chronic anal fissure: A case-control study
Beatrice D'Orazio, Girolamo Geraci, Fausto Famà, Gloria Terranova, Gaetano Di Vita
World Journal of Clinical Cases.2021; 9(32): 9722. CrossRef
Scanner-Assisted CO2 Laser Fissurectomy: A Pilot Study
Iacopo Giani, Tommaso Cioppa, Chiara Linari, Filippo Caminati, Paolo Dreoni, Gianni Rossi, Cinzia Tanda, Giuseppina Talamo, Federico Bettazzi, Alessandra Aprile, Silvia Grassi, Antonella Pede, Luca Giannoni, Claudio Elbetti
Frontiers in Surgery.2021;[Epub] CrossRef
Fissurectomy combined with botulinum toxin A: a review of short- and long-term efficacy of this treatment strategy for chronic anal fissure; a consecutive proposal of a treatment algorithm for chronic anal fissure
M. Trzpis, J. M. Klaase, R. H. Koop, P. M. A. Broens
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