title: Comparative study of conventional lateral internal sphincterotomy, V-Y anoplasty, and tailored lateral internal sphincterotomy with V-Y anoplasty in the treatment of chronic anal fissure.
abstract: BACKGROUND
  Lateral internal sphincterotomy has been proven highly effective in curing anal fissure but with a high incidence of postoperative incontinence.
  
  
  OBJECTIVE
  We compared conventional lateral internal sphincterotomy, V-Y advancement flap, and combined tailored lateral internal sphincterotomy with V-Y advancement flap in treating anal fissure.
  
  
  METHODS
  Consecutive patients treated for anal fissure at our colorectal unit were evaluated for inclusion. Participants were randomly allocated to receive conventional sphincterotomy (GI), V-Y advancement flap (GII), or combined tailored lateral sphincterotomy with V-Y advancement l flap (GIII).
  
  
  METHODS
  The primary outcome measure was the incontinence rate; secondary outcomes included healing rate, operative time, anal manometery, and recurrence rate.
  
  
  RESULTS
  One hundred fifty patients with chronic anal fissure were randomized. Healing rate after 1 year was 84% in GI, 48% in GII, and 94% in GIII, respectively (P = 0.001). The recurrence rate was 4% in G1, 22% in GII, and 2% in GIII (P = 0.01). Incontinence rate was 14% in GI, 0% in GII, and 2% in GIII (P = 0.03).
  
  
  CONCLUSIONS
  Although all three procedures are simple and easy to perform, tailored lateral internal sphincterotomy with V-YF appears to produce the greatest healing rate, with the fewest complications and less rate of recurrence.
authors.affiliation: Mansoura University Hospital, Mansoura, Egypt.
authors.forename: Alaa
authors.initials: A
authors.lastname: Magdy
authors.forename: Ayman
authors.initials: A
authors.lastname: El Nakeeb
authors.forename: El Yamani
authors.initials: el Y
authors.lastname: Fouda
authors.forename: Mohamed
authors.initials: M
authors.lastname: Youssef
authors.forename: Mohamed
authors.initials: M
authors.lastname: Farid
mesh_terms: D000293:Adolescent; D000328:Adult; D001003:Anal Canal / Q000601:surgery*; D000704:Analysis of Variance; D002908:Chronic Disease; D005242:Fecal Incontinence / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D005401:Fissure in Ano / Q000601:surgery*; D006801:Humans; D057194:Intention to Treat Analysis; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000379:methods*; D012008:Recurrence; D013524:Surgical Flaps; D016896:Treatment Outcome; D014945:Wound Healing; D055815:Young Adult