title: Mucosal advancement flap anoplasty for chronic anal fissure resistant to conservative therapy.
abstract: BACKGROUND
  Sphincter-sparing procedures are increasingly advocated in the treatment of chronic anal fissures (CAF) resistant to conservative management. Herein, we report about our results with sphincter-sparing transanal mucosal advancement flap anoplasty (MAAP) to treat CAF.
  
  
  METHODS
  The present study was a retrospective single-center analysis of patients in whom conservative management of CAF failed and who subsequently underwent MAAP between January 2003 and December 2008.
  
  
  RESULTS
  A total of 26 patients with a median age of 46.5 years (range: 17-79 years) had undergone MAAP after suffering with CAF for a median period of 9 months (range: 4-36 months). Surgery was well tolerated in all patients. One patient developed a perianal abscess at the operative site 3 weeks after MAAP, which required excision. At 2, 12, and 24 months follow-up, all patients were free of pain with no fissure recurrence or any worsening of incontinence.
  
  
  CONCLUSIONS
  Mucosal advancement flap anoplasty might be another sphincter-sparing treatment option in patients suffering from CAF. To draw final conclusions about the value of MAAP in the treatment of CAF, more solid data are required.
authors.affiliation: Département de Chirurgie Digestive et Oncologique, Service de Chirurgie Digestive et Oncologique, Pôle d'Oncologie des Spécialités Médicales et Chirurgicales, Hôpital Timone, 267, Rue Saint Pierre, 13385, Marseille Cedex 05, France. mehdi.ouaissi@mail.ap-hm.fr
authors.forename: M
authors.initials: M
authors.lastname: Ouaïssi
authors.forename: U
authors.initials: U
authors.lastname: Giger
authors.forename: I
authors.initials: I
authors.lastname: Sielezneff
authors.forename: K A
authors.initials: KA
authors.lastname: Yawovi
authors.forename: A
authors.initials: A
authors.lastname: Pamela
authors.forename: N
authors.initials: N
authors.lastname: Pirro
authors.forename: B
authors.initials: B
authors.lastname: Sastre
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019072:Antibiotic Prophylaxis; D002908:Chronic Disease; D015331:Cohort Studies; D005260:Female; D005401:Fissure in Ano / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000601:surgery*; D011300:Preoperative Care / Q000379:methods; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013524:Surgical Flaps / Q000098:blood supply*; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology*; D055815:Young Adult