S. Meenaa Saravanaperumaal1, R. Ravi2, P. Balamurugan3, S. Natarajan4
BACKGROUND
Anal fissure is an elongated ulcer in the long axis of lower anal canal. The most frequent site for anal fissure is midline posteriorly and followed by midline anteriorly. It causes severe pain during defecation and rectal bleeding that stain the tissue or streaks the stools.
Chronic anal fissure has traditionally been treated by surgery, an effective and standard procedure that results in healing in 90-95% of cases. Lateral sphincterotomy heals chronic anal fissure in 90% of cases that is associated with incontinence to flatus and faeces.
Anal advancement flaps was used to cover the chronic anal fissure. Using anal flaps to resurface chronic or recurrent anal fissure to promote wound healing and to assess the added advantage over lateral sphincterotomy in tissues of complete epithelialisation; time of relief of pain; persistent symptoms; patient satisfaction and quality of life.
The aim of the study is to-
1. Compare the efficacy of lateral sphincterotomy against lateral sphincterotomy with V-Y advancement flap in treatment of chronic anal fissures.
2. Assess the added advantages of V-Y advancement flap in treatment of chronic anal fissure in terms of wound healing, time of relief of pain, persistent symptoms and patients’ satisfaction.
3. Compare the complications associated with procedures.
MATERIALS AND METHODS
A study of 50 patients was done. It included 26 females and 24 males. In that, lateral sphincterotomy alone was done in 25 patients and lateral sphincterotomy along with anal advancement flap was done in 25 patients.
RESULTS
In group A patients only lateral sphincterotomy done. In group B lateral sphincterotomy with anal advancement flap done. Anal advancement flap done by ‘v’ shaped flap formed of skin and subcutaneous tissue was elevated incontinuity with excised tissue to allow to cover the tissue defect. Flap should be broad based with adequate blood supply and avoid tension while suturing with 3-0 vicryl. A study of 50 patients was done. It included 26 females and 24 males. In that lateral sphincterotomy alone was done in 25 patients and lateral sphincterotomy along with anal advancement flap was done in 25 patients.
CONCLUSION
Lateral sphincterotomy with advancement flap gives good postoperative pain relief, earlier healing of fissure and patients are more comfortable in their postoperative period even though the procedure involves considerable dissection and required increased operative time.
