Comparison of Fissurectomy to Fissurectomy With Anoplasty

Study Overview
=================
Brief Summary
-----------------
Surgery is sometimes necessary to relieve patients with chronic anal fissure. It consists of resecting the edges of the fissure to make a wound larger than the initial fissure, in order to obtain healing. Thus, the edges of the wound do not stick together and the healing is done from the bottom of the wound. This procedure is widely performed in France with results that seem satisfactory. In addition to resection of the fissure, a partial closure of the wound can be associated with a small flap of rectal mucosa which is sutured with a few absorbable stitches: this is anoplasty.

Detailed Description
-----------------
There is some debate as to whether to perform a fissurectomy alone or to complement it with an anoplasty to accelerate healing. The choice of technique performed depends on the training and habits of the operators but the results of fissurectomy alone and fissurectomy with anoplasty have never been compared. In the medical-surgical proctology department of the Groupe Hospitalier Paris Saint-Joseph (GHPSJ), both procedures are performed. The investigators therefore decided to compare the after-effects of fissurectomies alone with those of fissurectomies with anoplasty that were performed in the department in 2019. The choice between the 2 procedures is left exclusively to the discretion of the operator. The criteria for choice between the two patient populations are not different.

Official Title
-----------------
Comparison of Fissurectomy to Fissurectomy With Anoplasty

Conditions
-----------------
Fissure Rectal

Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Major patient Patient managed in the proctology department of Groupe hospitalier Paris Saint-Joseph for single posterior idiopathic fissures (anoplasty possible only in the context of non-infected posterior fissure) between January 1 and December 31, 2019 by fissurectomy alone or fissurectomy with anoplasty Exclusion Criteria: anterior or bipolar fissure infected fissure history of proctological surgery Crohn's disease HIV infection tubercular lesion validated by anatomopathology history of pelvic-perineal radiotherapy Tumor cells on histology fissurectomy +/- anoplasty associated with another proctological surgical procedure patient under guardianship or curatorship patient deprived of liberty patient under court protection Patient opposing the use of his data for this research

Ages Eligible for Study
-----------------
Minimum Age: 18 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Patients operated by fissurectomy<br> | |
| Patients operated by fissurectomy with anoplasty<br> | |

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Compare the effectiveness of the two techniques on the disappearance of pain related to anal fissure | Difference between the 2 groups in terms of percent of patients free of pain at Day 15 postoperatively | Day 15 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Compare the two techniques for the rate of complications | Difference between the 2 groups of patients at Day 15 post-operative in terms of complication rate | Day 15 | 
| Compare the two techniques for the healing rate | Difference between the 2 groups of patients at Day 15 post-operative in terms of healing rate | Day 15 | 
| Compare the two techniques for the rate of non-healing | Difference between the 2 groups of patients at Day 15 post-operative in terms of non-healing rate | Day 15 | 
| Compare the two techniques for the recurrence rate | Difference between the 2 groups of patients at Day 15 post-operative in terms of revision rate | Day 15 | 
| Compare the two techniques for the rate of revision surgery | Difference between the 2 groups of patients at D15 postoperatively in terms of revision rate | Day 15 | 
| Search for predictive factors of failure of each technique | Uni- and multivariate analyses to identify risk factors for failure for each technique | Day 15 |