Treatment of chronic anal fissure. Results away from anaplasties.

Abstract

INTRODUCTION: Anal fissure is a tear in the ectodermal anal mucosa. It is presented with intense anal pain and it is a common but usually underdiagnosed condition. Its form of presentation can be acute, which can heal with adequate medical treatment, but if it is not well implemented it evolves into chronicity, forming the chronic anal fissure complex. Its etiology is possibly multifactorial, the most important causes being thick and hard stools, or other types of anal trauma. Sphincter hypertonia would be the cause or the consequence of the trauma. It would produce ischemia that makes scarring difficult.

DESIGN: A retrospective and descriptive study of 168 patients with chronic primary anal fissure operated between 2010 and 2018 using a skin flap slipped to a subcutaneous pedicle was carried out.METHODS: All people were indicated mechanical preparation prior to the intervention. They underwent general anesthesia and settled in the Sevillian razor position. The fissurectomy was performed after identifying the anal sphincter, which was respected, and a skin flap was carved into a subcutaneous pedicle that was slid and anchored at the level of the pectineal line with a 5-0 vicryl surget.RESULTS: 58.33% were female and 41.66% male, with an age range between 28 and 72 years. Post-operative analgesia was indicated, and after discharge, 85% did not require analgesic rescue. No patient reported horrible or extreme pain. The healing time ranged from 4 to 8 weeks. There was no recurrence or persistence of the fissure.

CONCLUSIONS: Patients with chronic anal fissure can be treated with a subcutaneous pedicle anal skin flap with good results. Anoplasty is a simple, reproducible, well-tolerated technique, does not cause fecal continence disorder, and has high long-term cure and satisfaction rates. Therefore, it should be considered the technique of choice in the treatment of chronic anal fissure.