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Journal of Chinese Integrative Medicine ›› 2011, Vol. 9 ›› Issue (4): 402-409.doi: 10.3736/jcim20110409

• Original Clinical Research • Previous Articles     Next Articles

Mucosa advancement flap anoplasty in treatment of chronic anal fissures: A prospective, multicenter, randomized controlled trial

Zhen-yi Wang1(), Hua Liu1, Jian-hua Sun1, Xu-ming Mao2, Wei-xiang Xu3, Ying-ge Wu1, Hai-yan Zhang1, Li-juan Zhu3, Wei Jin1, Jiong Wu1, Ying Li1, Chuang Wu1, Zai-long Jiang1, Li Shi1, Yan Li2, Wei Dong2   

  1. 1. Department of Coloproctology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine,Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China
    2. Department of Coloproctology, Shanghai Ninth Peopled Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
    3. Department of Coloproctology, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200071, China
  • Received:2010-10-25 Accepted:2010-11-24 Online:2011-04-20 Published:2011-04-15
  • Contact: Wang Zhen-yi E-mail:drxinhuo@yahoo.com.cn

Background: Anal fissure is one of the most common anal-rectum diseases, and approximately 10 percent patients with chronic anal fissure ultimately receive surgery. Relieving postoperative pain and protecting functions of the sphincter are central issues for coloproctologists.
Objective: To evaluate the efficacy and safety of anoplasty in the treatment of chronic anal fissures.
Design, setting, participants and interventions: In this prospective, multicenter, randomized controlled trial, 120 adult patients with chronic anal fissure were referred from Department of Coloproctology of Yueyang Hospital of Integrated Traditional Chinese Medicine Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine and Shanghai Municipal Hospital of Traditional Chinese Medicine. The patients were enrolled from January 2009 to April 2010 and randomly divided into study (mucosa advancement flap anoplasty, abbreviated as anoplasty) group and control (fissurectomy) group. The two groups were assessed separately, and the main outcome measures were observed for 2 weeks, with a short-term follow-up for 6 weeks.
Main outcome measures: Degree of pain, haemorrhage and anal canal pressure were observed and recorded preoperatively, and on the third day, the fourteenth day and the sixth week postoperatively. The wound healing time was also recorded. Surgical complications of the two groups were recorded and compared on the third day and the sixth week postoperatively. The curative effects associated with the surgery were analyzed on the fourteenth day and the sixth week after surgery and the therapeutic results were evaluated.
Results: Three patients were dropped out due to the early discharge from hospital and losing connection (1 in study group and 2 in control group). Overall the surgery showed that the anoplasty group had better results than the fissurectomy group in the curative effect on the sixth week after operation (P<0.05). Time of wound healing in the anoplasty group was (17.22±4.41) d and was better than (21.24±7.44) d of the fissurectomy group (P<0.05). Concerning the relief of wound pain, the anoplasty group achieved better results than the fissurectomy group at the third day, the fourteenth day and the sixth week after operation (P<0.05). Anoplasty reduced bleeding and had better efficacy than the fissurectomy at the third day and the fourteenth day after operation (P<0.05), however, there was no statistical difference at the sixth week after operation (P>0.05). There were no significant differences in relieving the anal canal pressure (P>0.05) and the surgical complications (dysuria, edema of anal margin, fever, infection, anal incontinence and anal deformation) between the two groups (P>0.05). None of the patients suffered postoperative complications by the sixth week after operation. Furthermore, there was no recurrence in either of the two groups at six weeks after operation.
Conclusion: The results indicate that anoplasty for chronic anal fissures has advantages such as better therapeutic effects, less postoperative pain, a shorter healing time and no incidence of anal incontinence.

Key words: chronic anal fissure, fissure in ano, mucosa advancement flap anoplasty, multicenter study, randomized controlled trials, prospective studies

Figure 1

Flow diagram of this randomized trial"

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[1] Shi HZ, Ren BY . Epidemiological analysis of anorectal diseases[J]. Zhongguo Gang Chang Bing Za Zhi, 2000,20(3):10-12
石焕芝, 任宝印 . 肛门直肠疾病流行病学分析[J]. 中国肛肠病杂志, 2000,20(3):10-12
[2] Ray JE, Penfold JC, Gathright JB Jr, Roberson SH . Presidential address. Lateral subcutaneous internal anal sphincterotomy for anal fissure[J]. Dis Colon Rectum, 1974,17(2):139-144
doi: 10.1007/BF02588095
[3] Leong AF, Seow-Choen F . Lateral sphincterotomy compared with anal advancement flap for chronic anal fissure[J]. Dis Colon Rectum, 1995,38(1):69-71
doi: 10.1007/BF02053862 pmid: 7813349
[4] Shanghai Municipal Health Bureau. Criteria for diagnosis and treatment of traditional Chinese medicine syndromes in Shanghai(2nd ed)[M]. Shanghai: Shanghai University of Traditional Chinese Medicine Press, 2003: 328-329
上海市卫生局. 上海市中医病证诊疗常规(第2版)[M]. 上海: 上海中医药大学出版社, 2003: 328-329
[5] Zheng XY. Guidelines for clinical research on Chinese new herbal medicines[M]. Beijing: China Medical Science Press, 2002,: 129-134
郑筱萸 . 中药新药临床研究指导原则[M]. 北京: 中国医药科技出版社, 2002: 129-134
[6] Wu ZD, Wu ZH. Surgery(6th ed)[M]. Beijing: People’s Medical Publishing House, 2004: 522
吴在德, 吴肇汉 .外科学 ( 第6版)[M]. 北京: 人民卫生出版社, 2004: 522
[7] Argov S, Levandovsky O . Open lateral sphincterotomy is still the best treatment for chronic anal fissure[J]. Am J Surg, 2000,179(3):201-202
doi: 10.1016/S0002-9610(00)00307-X pmid: 10827320
[8] Elsebae MM . A study of fecal incontinence in patients with chronic anal fissure: prospective, randomized, controlled trial of the extent of internal anal sphincter division during lateral sphincterotomy[J]. World J Surg, 2007,31(10):2052-2057
doi: 10.1007/s00268-007-9177-1
[9] Nyam DC, Wilson RG, Stewart KJ, Farouk R, Bartolo DC . Island advancement flaps in the management of anal fissures[J]. Br J Surg, 1995,82(3):326-328
doi: 10.1002/bjs.1800820315 pmid: 7795999
[10] Hancke E, Rikas E, Suchan K, Volke K . Dermal flap coverage for chronic anal fissure: lower incidence of anal incontinence compared to lateral internal sphincterotomy after long-term follow-up[J]. Dis Colon Rectum, 2010,53(11):1563-1568
doi: 10.1007/DCR.0b013e3181f0869f
[11] Jonas M, Scholefield JH . Anal fissure[J]. Gastroenterol Clin North Am, 2001,30(1):167-181
doi: 10.1016/S0889-8553(05)70172-2
[12] Giordano P, Gravante G, Grondona P, Ruggiero B, Porrett T, Lunniss PJ . Simple cutaneous advancement flap anoplasty for resistant chronic anal fissure: a prospective study[J]. World J Surg, 2009,33(5):1058-1063
doi: 10.1007/s00268-009-9937-1
[13] Huang F . Clinical study of painless integrated Chinese and Western medicine surgery treatment of anorectal diseases[J]. Hebei Zhong Yi, 2003,25(3):217-218
doi: 10.3969/j.issn.1002-2619.2003.03.037
黄峰 . 中西医结合肛肠病手术“无痛化”的临床探讨[J]. 河北中医, 2003,25(3):217-218
doi: 10.3969/j.issn.1002-2619.2003.03.037
[14] Yang JF, Wang YJ, Chang SX . Analysis of the reasons and treatment for postoperative pain of patients with anorectal disease[J]. Zhongguo Jiao Tong Yi Xue Za Zhi, 2006,20(1):95
doi: 10.3969/j.issn.1006-2440.2006.01.054
杨建芳, 王彦君, 常淑娴 . 肛肠病患者术后疼痛的原因分析及处理[J]. 中国交通医学杂志, 2006,20(1):95
doi: 10.3969/j.issn.1006-2440.2006.01.054
[15] Huang NJ. Study on anorectal diseases in China[M]. Jinan: Shandong Science and Technology Publishing House, 2004: 213
黄乃健 . 中国肛肠病学[M]. 济南: 山东科学技术出版社, 2004: 213
[16] Huang ZQ . Minimally invasive surgery is the most important study of surgery in the 21st century[J]. Zhonghua Wai Ke Za Zhi, 2002,40(1):9-11
doi: 10.3760/j:issn:0529-5815.2002.01.004
黄志强 . 微创外科与外科微创化——2l世纪外科的主旋律[J]. 中华外科杂志, 2002,40(1):9-11
doi: 10.3760/j:issn:0529-5815.2002.01.004
[17] Patti R, Famà F, Tornambè A, Asaro G, Di Vita G . Fissurectomy combined with anoplasty and injection of botulinum toxin in treatment of anterior chronic anal fissure with hypertonia of internal anal sphincter: a pilot study[J]. Tech Coloproctol, 2010,14(1):31-36
doi: 10.1007/s10151-009-0562-7
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