Ann Coloproctol.  2018 Apr;34(2):83-87. 10.3393/ac.2017.06.12.

Long-term Outcome of a Fissurectomy: A Prospective Single-Arm Study of 50 Operations out of 349 Initial Patients

Affiliations
  • 1Proctologie Médico-Interventionnelle, Groupe Hospitalier Diaconesses – Croix-Saint-Simon, Paris, France. jdzeitoun@yahoo.fr
  • 2Gastroentérologie et Nutrition, Hôpital Saint-Antoine, Paris, France.
  • 3Service de Biostatistiques et d'Epidémiologie, Institut Gustave Roussy, Villejuif, France.
  • 4Proctologie Médico-Chirurgicale, Institut Léopold Bellan, Groupe Hospitalier Paris Saint-Joseph, Paris, France.

Abstract

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.

Keyword

Anal fissure; Fissurectomy; Anal continence

MeSH Terms

Fissure in Ano
Follow-Up Studies
Humans
Outcome Assessment (Health Care)
Prospective Studies*
Standard of Care
Wound Healing
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