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Comparative Study of Conventional Lateral Internal Sphincterotomy, V-Y Anoplasty, and Tailored Lateral Internal Sphincterotomy with V-Y Anoplasty in the Treatment of Chronic Anal Fissure

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Lateral internal sphincterotomy has been proven highly effective in curing anal fissure but with a high incidence of postoperative incontinence.

Objective

We compared conventional lateral internal sphincterotomy, V-Y advancement flap, and combined tailored lateral internal sphincterotomy with V-Y advancement flap in treating anal fissure.

Patients

Consecutive patients treated for anal fissure at our colorectal unit were evaluated for inclusion. Participants were randomly allocated to receive conventional sphincterotomy (GI), V-Y advancement flap (GII), or combined tailored lateral sphincterotomy with V-Y advancement l flap (GIII).

Main Outcome Measures

The primary outcome measure was the incontinence rate; secondary outcomes included healing rate, operative time, anal manometery, and recurrence rate.

Results

One hundred fifty patients with chronic anal fissure were randomized. Healing rate after 1 year was 84 % in GI, 48 % in GII, and 94 % in GIII, respectively (P = 0.001). The recurrence rate was 4 % in G1, 22 % in GII, and 2 % in GIII (P = 0.01). Incontinence rate was 14 % in GI, 0 % in GII, and 2 % in GIII (P = 0.03).

Conclusion

Although all three procedures are simple and easy to perform, tailored lateral internal sphincterotomy with V-YF appears to produce the greatest healing rate, with the fewest complications and less rate of recurrence.

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Authors and Affiliations

  1. Mansoura University Hospital, Mansoura, Egypt

    Alaa Magdy, Ayman El Nakeeb, El Yamani Fouda, Mohamed Youssef & Mohamed Farid

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  1. Alaa Magdy
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  2. Ayman El Nakeeb
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  3. El Yamani Fouda
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  4. Mohamed Youssef
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  5. Mohamed Farid
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Correspondence to Ayman El Nakeeb.

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Magdy, A., El Nakeeb, A., Fouda, E.Y. et al. Comparative Study of Conventional Lateral Internal Sphincterotomy, V-Y Anoplasty, and Tailored Lateral Internal Sphincterotomy with V-Y Anoplasty in the Treatment of Chronic Anal Fissure. J Gastrointest Surg 16, 1955–1962 (2012). https://doi.org/10.1007/s11605-012-1984-5

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