Conventional Lateral Internal Sphincterotomy, V-Y Anoplasty and Tailored Lateral Internal Sphincterotomy With V-YF in Treatment of Chronic Anal Fissure(CAF)
Condition: Chronic Anal Fissure
MeSH terms: Fissure in Ano
Study type: Interventional

Summary: 
      The investigators compared conventional lateral internal sphincterotomy (CLIS), V-Y anal
      flap, and combined tailored lateral internal sphincterotomy with V-Y anal flap (TLIS with
      V-YF) in a randomized prospective study in patients undergoing treatment for chronic anal
      fissure.
    

Detailed description: 
      Group I: Conventional Lateral internal sphincterotomy:

      LIS was performed in the lithotomy position by a standard open technique, briefly; a 5-mm
      incision was made into the perianal skin along the intersphinteric groove. The internal anal
      sphincter was then dissected and a segment withdrawn with a pair of artery forces and divided
      with diathermy to the level of the dentate line. Figures 5, 6, 7 and 8 illustrate the
      procedure.

      GroupII: V-Y advancement flap:

      The V-Y advancement flap was performed by making a V-shaped incision from the edges of the
      fissure extending about 4 cm from the anal verge and away from the midline. The V-shaped flap
      formed of skin and subcutaneous fat was mobilized sufficiently to allow advancement into the
      anal canal to cover the fissure defect. Care was taken to preserve enough pedicles to ensure
      adequate blood supply. The base of flap was sutured to the lower anal mucosa with interrupted
      000 Vicryl Rapide. Figures 1, 2, 3 and 4 illustrate the procedure.

      GroupIII: Tailored lateral internal sphincterotomy with V-Y advancement flap:

      Tailored lateral sphincterotomy was performed in the lithotomy position by a standard open
      technique, briefly; a 5-mm incision was made into the perianal skin along the intersphinteric
      groove. The internal anal sphincter was then dissected and a segment withdrawn with a pair of
      artery forces and divided with diathermy, the extent of sphincterotomy was done to be more or
      less equal to the length of the fissure. Then the V-Y advancement flap was performed All
      assessments were conducted by investigators who were blinded to the experimental condition.
      The primary outcome was complete healing (complete epithelization scare or no sign of
      fissure, healing was considered to be delayed if the wound had not completely healed by 6
      weeks after the procedure). Secondary outcomes were operative time, length of hospital stay,
      anal incontinence (determined by Pescatori scoring system (32), time of relieve of pain,
      postoperative anal manometery, complications (eccyhmosis, haematoma, infection, disruption of
      flap, flap necrosis), persistent symptoms, patients satisfaction ( assessed on a visual
      analogue scale VAS), recurrence rate and quality of life.

      Quality of life was assessed using the Gastrointestinal Quality of Life Index (GIQLI)
      developed by Eypasch and coworkers
    

Intervention name(s): Group I: Conventional Lateral internal sphincterotomy:; GroupII: V-Y advancement flap; GroupIII: Tailored LIS with V-Y advancement flap
Intervention type(s): Procedure; Procedure; Procedure
Intervention description(s): LIS was performed in the lithotomy position by a standard open technique, briefly; a 5-mm incision was made into the perianal skin along the intersphinteric groove. The internal anal sphincter was then dissected and a segment withdrawn with a pair of artery forces and divided with diathermy to the level of the dentate line. Figures 5, 6, 7 and 8 illustrate the procedure.; GroupII: V-Y advancement flap:
The V-Y advancement flap was performed by making a V-shaped incision from the edges of the fissure extending about 4 cm from the anal verge and away from the midline. The V-shaped flap formed of skin and subcutaneous fat was mobilized sufficiently to allow advancement into the anal canal to cover the fissure defect. Care was taken to preserve enough pedicles to ensure adequate blood supply. The base of flap was sutured to the lower anal mucosa with interrupted 000 Vicryl Rapide.; Tailored lateral sphincterotomy was performed in the lithotomy position by a standard open technique, briefly; a 5-mm incision was made into the perianal skin along the intersphinteric groove. The internal anal sphincter was then dissected and a segment withdrawn with a pair of artery forces and divided with diathermy, the extent of sphincterotomy was done to be more or less equal to the length of the fissure. Then the V-Y advancement flap was performed.
Other intervention name(s): Group 1; Group 11; Group III
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Investigator)
Primary purpose: Treatment
Keywords: Anal fissure; Advancement flap; Internal sphincterotomy