General Surgery 3 O.U., Molinette Hospital, University Hospital Città Della Salute E Della Scienza di Torino, Turin, Italy.
Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy.
Tech Coloproctol. 2023 Oct;27(10):885-889. doi: 10.1007/s10151-023-02780-8. Epub 2023 Mar 16.
The standard treatment for chronic anal fissures that have failed non-operative management is lateral internal sphincterotomy. Surgery can cause de novo incontinence. Fissurectomy has been proposed as a sphincter/saving procedure, especially in the presence of a deep posterior pouch with or without a crypt infection. This study investigated whether fissurectomy offers a benefit in terms of de novo post-operative incontinence.
Patients surgically managed with fissurectomy or lateral internal sphincterotomy for chronic anal fissures from 2013 to 2019 have been included. Healing rate, changes in continence and patient satisfaction were investigated at long-term follow-up.
One hundred twenty patients (55 females, 65 males) were analysed: 29 patients underwent fissurectomy and 91 lateral internal sphincterotomy. Mean follow-up was 55 months [confidence interval (CI) 5-116 months]. Both techniques showed some rate of de novo post-operative incontinence (> +3 Vaizey score points): 8.9% lateral internal sphincterotomy, 17.8% fissurectomy (p = 0.338). The mean Vaizey score in these patients was 10.37 [standard deviation (sd) 6.3] after lateral internal sphincterotomy (LIS) and 5.4 (sd 2.3) after fissurectomy Healing rate was 97.8% in the lateral internal sphincterotomy group and 75.8% in the fissurectomy group (p = 0.001). In the lateral internal sphincterotomy group, patients with de novo post-op incontinence showed a statistically significant lower satisfaction rate (9.2 ± 1.57 versus 6.13 ± 3; p = 0.023) while no differences were present in the fissurectomy group (8.87 ± 1.69 versus 7.4 ± 1.14; p = 0.077).
Lateral internal sphincterotomy is confirmed as the preferred technique in term of healing rate. Fissurectomy did not offer a lower rate of de novo post-operative incontinence, but resulted in lower Vaizey scores in patients in whom this occurred. Satisfaction was lower in patients suffering a de novo post-operative incontinence after lateral internal sphincterotomy.
对于非手术治疗失败的慢性肛裂，标准治疗方法是侧方内括约肌切开术。手术可能导致新发性失禁。肛裂切除术被提议作为一种保留括约肌的手术方法，尤其是在后侧深袋伴有或不伴有隐窝感染的情况下。本研究旨在探讨肛裂切除术在新发性术后失禁方面是否具有优势。
纳入了 2013 年至 2019 年接受肛裂切除术或侧方内括约肌切开术治疗的慢性肛裂患者。在长期随访中，调查了愈合率、控便能力的变化和患者满意度。
120 例患者（55 例女性，65 例男性）纳入分析：29 例患者接受肛裂切除术，91 例患者接受侧方内括约肌切开术。平均随访时间为 55 个月[置信区间（CI）5-116 个月]。两种技术都有一定比例的新发性术后失禁（>3 Vaizey 评分点）：侧方内括约肌切开术 8.9%，肛裂切除术 17.8%（p=0.338）。这些患者的平均 Vaizey 评分为侧方内括约肌切开术（LIS）后 10.37[标准差（sd）6.3]，肛裂切除术后 5.4[sd 2.3]。侧方内括约肌切开术组的愈合率为 97.8%，肛裂切除术组为 75.8%（p=0.001）。在侧方内括约肌切开术组中，新发术后失禁的患者满意度明显较低（9.2±1.57 与 6.13±3；p=0.023），而肛裂切除术组无差异（8.87±1.69 与 7.4±1.14；p=0.077）。
侧方内括约肌切开术在愈合率方面被证实为首选技术。肛裂切除术并未降低新发性术后失禁的发生率，但在发生这种情况的患者中，Vaizey 评分较低。侧方内括约肌切开术后新发术后失禁的患者满意度较低。
