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Fissurectomy and anoplasty in posterior normotensive chronic anal fissure

PURPOSE: Anal Fissure (AF) is the second most frequent proctological disease in Italy. Chronic AF (CAF) most common located at the posterior anal commissure (CAPF). CAPF are thought to be associated with hypertonic internal anal sphincter (IAS) but manometric findings showed that a normotonic IAS is...

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Autores principales: D’Orazio, Beatrice, Bonventre, Sebastiano, Famà, Fausto, Sciumé, Carmelo, Cudia, Bianca, Calì, Dario, Corbo, Giovanni, Di Vita, Gaetano, Geraci, Girolamo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Mattioli 1885 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8689339/
https://www.ncbi.nlm.nih.gov/pubmed/34738577
http://dx.doi.org/10.23750/abm.v92i5.11200
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author D’Orazio, Beatrice
Bonventre, Sebastiano
Famà, Fausto
Sciumé, Carmelo
Cudia, Bianca
Calì, Dario
Corbo, Giovanni
Di Vita, Gaetano
Geraci, Girolamo
author_facet D’Orazio, Beatrice
Bonventre, Sebastiano
Famà, Fausto
Sciumé, Carmelo
Cudia, Bianca
Calì, Dario
Corbo, Giovanni
Di Vita, Gaetano
Geraci, Girolamo
author_sort D’Orazio, Beatrice
collection PubMed
description PURPOSE: Anal Fissure (AF) is the second most frequent proctological disease in Italy. Chronic AF (CAF) most common located at the posterior anal commissure (CAPF). CAPF are thought to be associated with hypertonic internal anal sphincter (IAS) but manometric findings showed that a normotonic IAS is present in the 20-40%. Sphincterotomy is often recommended as treatment of choice for CAF independently from IAS tone; nevertheless, this approach appears less logical for CAF with normotonic IAS, as in those cases there’s a higher risk of post-operative anal incontinence. The aim of this study is to evaluate the results of fissurectomy and anoplasty with V-Y cutaneous advancement flap, as treatment for patients suffering from CAPF without hypertonic IAS. METHODS: We enrolled 30 patients affected by CAPF without IAS hypertonia. All patients were followed up for 2 years after the surgical procedure, with evaluation of anal continence, recurrence rate and maximum resting pressure, maximum squeeze pressure, ultraslow wave activity. RESULTS: All patients healed within 40 days after surgery. We didn’t observe any “de novo” post-operative anal incontinence cases. We reported 2 cases of recurrences, within 18 months from surgery, all healed after conservative therapy. We didn’t record statistically significant differences in pre- and post-operative manometry findings. CONCLUSION: At 2 years after the surgical procedure we achieved good results, these evidences shows that sphincter preserving procedures are more suitable for CAPF without hypertonic IAS.
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spelling pubmed-86893392022-01-06 Fissurectomy and anoplasty in posterior normotensive chronic anal fissure D’Orazio, Beatrice Bonventre, Sebastiano Famà, Fausto Sciumé, Carmelo Cudia, Bianca Calì, Dario Corbo, Giovanni Di Vita, Gaetano Geraci, Girolamo Acta Biomed Original Article PURPOSE: Anal Fissure (AF) is the second most frequent proctological disease in Italy. Chronic AF (CAF) most common located at the posterior anal commissure (CAPF). CAPF are thought to be associated with hypertonic internal anal sphincter (IAS) but manometric findings showed that a normotonic IAS is present in the 20-40%. Sphincterotomy is often recommended as treatment of choice for CAF independently from IAS tone; nevertheless, this approach appears less logical for CAF with normotonic IAS, as in those cases there’s a higher risk of post-operative anal incontinence. The aim of this study is to evaluate the results of fissurectomy and anoplasty with V-Y cutaneous advancement flap, as treatment for patients suffering from CAPF without hypertonic IAS. METHODS: We enrolled 30 patients affected by CAPF without IAS hypertonia. All patients were followed up for 2 years after the surgical procedure, with evaluation of anal continence, recurrence rate and maximum resting pressure, maximum squeeze pressure, ultraslow wave activity. RESULTS: All patients healed within 40 days after surgery. We didn’t observe any “de novo” post-operative anal incontinence cases. We reported 2 cases of recurrences, within 18 months from surgery, all healed after conservative therapy. We didn’t record statistically significant differences in pre- and post-operative manometry findings. CONCLUSION: At 2 years after the surgical procedure we achieved good results, these evidences shows that sphincter preserving procedures are more suitable for CAPF without hypertonic IAS. Mattioli 1885 2021 2021-11-03 /pmc/articles/PMC8689339/ /pubmed/34738577 http://dx.doi.org/10.23750/abm.v92i5.11200 Text en Copyright: © 2021 ACTA BIO MEDICA SOCIETY OF MEDICINE AND NATURAL SCIENCES OF PARMA https://creativecommons.org/licenses/by-nc-sa/4.0/This work is licensed under a Creative Commons Attribution 4.0 International License
spellingShingle Original Article
D’Orazio, Beatrice
Bonventre, Sebastiano
Famà, Fausto
Sciumé, Carmelo
Cudia, Bianca
Calì, Dario
Corbo, Giovanni
Di Vita, Gaetano
Geraci, Girolamo
Fissurectomy and anoplasty in posterior normotensive chronic anal fissure
title Fissurectomy and anoplasty in posterior normotensive chronic anal fissure
title_full Fissurectomy and anoplasty in posterior normotensive chronic anal fissure
title_fullStr Fissurectomy and anoplasty in posterior normotensive chronic anal fissure
title_full_unstemmed Fissurectomy and anoplasty in posterior normotensive chronic anal fissure
title_short Fissurectomy and anoplasty in posterior normotensive chronic anal fissure
title_sort fissurectomy and anoplasty in posterior normotensive chronic anal fissure
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8689339/
https://www.ncbi.nlm.nih.gov/pubmed/34738577
http://dx.doi.org/10.23750/abm.v92i5.11200
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