Long-term Outcome of a Fissurectomy: A Prospective Single-Arm Study of 50 Operations out of 349 Initial Patients

Jean-David Zeitoun; Pierre Blanchard; Nadia Fathallah; Paul Benfredj; Nicolas Lemarchand; Vincent de Parades

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저자정보: Jean-David Zeitoun (Groupe Hospitalier Diaconesses – Croix-Saint-Simon) Pierre Blanchard (Institut Gustave Roussy) Nadia Fathallah (Groupe Hospitalier Paris Saint-Joseph) Paul Benfredj (Groupe Hospitalier Paris Saint-Joseph) Nicolas Lemarchand (Groupe Hospitalier Paris Saint-Joseph) Vincent de Parades (Groupe Hospitalier Paris Saint-Joseph)

저널정보: 대한대장항문학회 Annals of Coloproctology Annals of Coloproctolgy Vol.34 No.2

발행연도: 2018.1

수록면: 83 - 87 (5page)

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Purpose: The surgical standard of care for patients with chronic anal fissure is still disputed. We aimed to assess the natural course of idiopathic anal fissure and the long-term outcome of a fissurectomy as a surgical treatment. Methods: All consecutive patients referred to a single expert practitioner in a tertiary centre were primarily included. A fissurectomy was proposed in cases of refractory symptoms after 4 to 6 weeks of standard medical management. Only patients with idiopathic and noninfected anal fissures were included in this second subsample to undergo surgery. Conventional postoperative management was prescribed for all patients who had undergone surgery. The main outcome measures were the success rate (defined as a combination of wound healing and relief of pain) and postoperative anal continence. Results: Three hundred forty-nine patients were primarily recruited. Fifty patients finally underwent surgery for an idiopathic and noninfected fissure. Among them, 47 (94%) were cured at the end of primary follow-up, and 44 of the 47 (93.6%) could be confirmed as being sustainably cured in the longer-term follow-up. The mean time of complete healing was 10.3 weeks (range, 5.7–36.4 weeks). All patients were free of pain at weeks 42. The continence score after surgery was not statistically different from the preoperative score. Conclusion: A fissurectomy for the treatment of patients with an idiopathic noninfected fissure is associated with rapid pain relief and a high success rate even though complete healing may often be delayed. Moreover, it appears to have no adverse effect on continence.

참고문헌 (17)

참고문헌 신청

Cross KL / 2008 / The management of anal fissure: ACPGBI position statement / Colorectal Dis 10(Suppl 3):1~7

Perry WB / 2010 / Practice parameters for the management of anal fissures (3rd revision) / Dis Colon Rectum 53:1110~1115

Altomare DF / 2011 / The management of patients with primary chronic anal fissure: a position paper / Tech Coloproctol 15:135~141

Garg P / 2013 / Long-term continence disturbance after lateral internal sphincterotomy for chronic anal fissure: a systematic review and meta-analysis / Colorectal Dis 15:e104~e117

Garcia-Granero E / 2009 / The ideal lateral internal sphincterotomy: clinical and endosonographic evaluation following open and closed internal anal sphincterotomy / Colorectal Dis 11:502~507

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