title: Simple cutaneous advancement flap anoplasty for resistant chronic anal fissure: a prospective study.
abstract: BACKGROUND
  A proportion of patients with chronic anal fissure have persistent symptoms and pathology despite optimum conservative therapies. Lateral anal sphincterotomy, the standard surgical treatment, is associated with functional compromise in a minority of patients. Sphincter-sparing anoplasty has been advocated as an alternative procedure for those with "low pressure" sphincters. The aim of this study was to determine the efficacy of simple cutaneous advancement flap anoplasty (SCAFA) when applied to consecutive patients with chronic anal fissure irrespective of anal tone and the patient's gender.
  
  
  METHODS
  This was a prospective outcome study of 51 consecutive patients treated with SCAFA over a 6.5-year period.
  
  
  RESULTS
  Surgery was well tolerated. There were three (5.9%) early flap dehiscences, all of which were treated with repeat SCAFA, and one of those three patients remained symptomatic at 2 months. All fissures healed in the short term. Three other patients subsequently developed fissures at sites remote from the original pathology. Continence was unaffected by the procedure.
  
  
  CONCLUSIONS
  Simple cutaneous advancement flap anoplasty should be considered as a first-line surgical treatment of chronic anal fissure, irrespective of patient gender and anal tone.
authors.affiliation: Department of Surgery, Whipps Cross University Hospital, Whipps Cross Road, London E11 1NR, UK. pasquale.giordano@whippsx.nhs.uk
authors.forename: Pasquale
authors.initials: P
authors.lastname: Giordano
authors.forename: Gianpiero
authors.initials: G
authors.lastname: Gravante
authors.forename: Pietro
authors.initials: P
authors.lastname: Grondona
authors.forename: Boris
authors.initials: B
authors.lastname: Ruggiero
authors.forename: Theresa
authors.initials: T
authors.lastname: Porrett
authors.forename: Peter James
authors.initials: PJ
authors.lastname: Lunniss
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000601:surgery; D002908:Chronic Disease; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D005401:Fissure in Ano / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013524:Surgical Flaps; D016896:Treatment Outcome; D014945:Wound Healing; D055815:Young Adult