Peculiarities of surgical treatment of anal fissure combined with chronic hemorrhoids

Authors

  • A. J. Noyes P. L. Shupyk National University of Health of Ukraine
  • Y. P. Feleshtinsky P. L. Shupyk National University of Health of Ukraine
  • V. Y. Pyrogovskyy P. L. Shupyk National University of Health of Ukraine

DOI:

https://doi.org/10.11603/2414-4533.2021.1.12026

Keywords:

hemorrhoids, anal fissure, laser Doppler flowmetry

Abstract

The aim of the work: to improve the results of treatment of patients with chronic hemorrhoids combined with chronic anal fissure by combining transanal hemorrhoidal dearterialization with fissurectomy.

Materials and Methods. We studied 177 patients with anal fissure and hemorrhoids, who were divided into three groups: GI – 60 patients who underwent Milligan-Morgan hemorrhoidectomy and fissurectomy, GII – 60 patients who underwent fissurectomy without intervention for hemorrhoids, GIII – 57 patients operated according to the original method. The results were evaluated according to the criteria: pain intensity, early urinary retention, wound suppuration, recurrence rate, incontinence, days of hospital stay. Laser Doppler flowmetry was performed to assess the intensity of blood flow in the area of ​​anal fissure.

Results and Discussion. There was a decrease in pain intensity from 8±1 in group I to 4±1 in group III (p = 0.006), a decrease of urinary retention incidence from 31.7 % in group I to 10.5 % in group III (p = 0.004). Wound suppuration rate was reduced from 8.3 % in group I to 1.7 % in group III (p = 0.104), which is comparable to the results obtained during surgical treatment for only anal fissure (without hemorrhoids) in group II. Postoperative hospital stay in group I was (6±1.2) days, group II – (4±1.3), group III (3±1.1) days. It was possible to reduce the incidence of fissure recurrence to 1 (1.7 %) and hemorrhoids to 2 (3.5 %) in group III, compared with 5 (8.3 %) and 6 (10 %) in group I. We did not observe any case of iatrogenic incontinence in patients of group III, compared with 4 (6.7 %) in group I and 1 (1.7 %) in group II. In groups III and II postoperative anal canal strictures were not observed, in group I strictures occurred in 5 (8.3 %) patients. A generalized estimate of the frequency of complications indicates a significant reduction in relative complication risk (88 %) in group III compared with group I – OR = 0.12 (0.04–0.29), p = 0.0001, and a tendency to reduction of complications risk by 15 % in comparison with group II – OR = 0.85 (0.29–2.4), p = 0.734.

References

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Published

2021-04-30

How to Cite

Noyes, A. J., Feleshtinsky, Y. P., & Pyrogovskyy, V. Y. (2021). Peculiarities of surgical treatment of anal fissure combined with chronic hemorrhoids. Hospital Surgery. Journal Named by L.Ya. Kovalchuk, (1), 77–81. https://doi.org/10.11603/2414-4533.2021.1.12026

Issue

No. 1 (2021)

Section

EXPERIENCE OF WORK

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