Peculiarities of surgical treatment of anal fissure combined with chronic hemorrhoids
DOI:
https://doi.org/10.11603/2414-4533.2021.1.12026Keywords:
hemorrhoids, anal fissure, laser Doppler flowmetryAbstract
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
Stewart, D.B., Gaertner, W., Glasgow, S., Migaly, J., Feingold, D., & Steele, S.R. (2017). Clinical practice guideline for the management of anal fissures. Diseases of the Colon & Rectum, 60 (1), 7-14.
Guttenplan, M. (2017). The evaluation and office management of hemorrhoids for the gastroenterologist. Current Gastroenterology Reports, 19 (7).
Kondrtenko, P.G., Gubergrits, N.B., Elin, F.E., & Smirnov, N.L. (2006). Klinicheskaya koloproktologiya: Rukovodstvo dlya vrachey [Clinical coloproctology: A guide for physicians]. Kharkiv: Fakt [in Russian].
Rayimbekov, O.R. (2015). Optimizatsiya lecheniya analnoy treshcheny v sochetanii s khronicheskim gemorroyem [Optimizing the treatment of anal fissure in combination with chronic hemorrhoids]. Molodoy uchenyy – Young Scientist, 21 (101), 303-305 [in Russian].
Ayantunde A.A., & Debrah S.A. (2006). Current concepts in anal fissures. World Journal of Surgery, 30 (12), 2246-2260.
Trenti, L., Biondo, S., Galvez, A., Bravo, A., Cabrera, J., & Kreisler, E. (2017). Distal Doppler-guided transanal hemorrhoidal dearterialization with mucopexy versus conventional hemorrhoidectomy for grade III and IV hemorrhoids: postoperative morbidity and long-term outcomes. Techniques in Coloproctology, 21(5), 337-344.
Nelson R. (2005) Operative procedures for fissure in ano. Cochrane Database System Revue., 18 (2).
Hsu T.C., & MacKeigan J.M. (1984). Surgical treatment of chronic anal fissure: a retrospective study of 1753 cases. Dis. Colon. Rectum, 27, 475-478.
Trilling, B., Pflieger, H., & Faucheron, J. L. (2017). Decreased blood flow to the posterior anal canal shown during Doppler-guided hemorrhoidal artery ligation explains anodermal ischemia in anal fissure. Techniques in Coloproctology, 21(5), 411-412.
Schouten W.R, Briel J.W, Auwerda J.J, & De Graaf E.J. (1996). Ischaemic nature of anal fissure. Br. J. Surg., 83, 63-65
Brown, S.R. (2017). Haemorrhoids: an update on management. Therapeutic Advances in Chronic Disease, 8 (10), 141-147
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