One-year outcome of fissurectomy: a Frenchprospective, multicenter study: LTP87


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Abstract

Aim:The gold standard treatment of anal fissure is lateral internal sphincterotomy. Many French operators perform fissurectomy ± anoplasty to avoid anal incontinence. We assessed the 1-year outcome of this technique.Method:Tenproctologists in France included all patients with chronic anal fissure and planned fissurectomy. Data were collected before surgery, at healing and 1 year post-surgery. Patients selfassessed symptoms (10-cm VAS) and quality of life (SF-36).Results:Two hundred and eighty-four patients participated (median age 48 years, 51% women). Median anal pain was 5/10. The main indications for fissurectomy were failure of topical/transit regulating agents (n = 242), sclerotherapy (12) orprior fissure surgery (7). Among the 277 patients evaluated at healing, 60 had fissurectomy and 217 had fissurectomy + anoplasty. Complications included: urinary retention (n = 3), local infection (3) and fecaloma (1). No bleeding requiring reoperation occurred. Median time to healing was 8 weeks. Healing seemed more rapid with anoplasty (7 vs 8 weeks, P = 0.07). Two hundred and fourteen patients had 1-year follow-up. Median Vaisey score was 2/24 before and 3/24 post-surgery (NS). Quality of life was extensively and significantly improved at healing and 1 year. Anal discomfort decreased from 4.9/10 before to 0.1/10 after surgery (P < 0.05).Conclusion:Fissurectomy allowed healing chronic anal fissure in all cases, without anal incontinence.

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