Comparative analysis of the treatment for chronic anal fissure using the methods of electrosurgical excision and laser destruction

• Cherepenin M.Yu.
• Lutkov I.V.
• Gorsky V.A.

Abstract

Aim – to analyze the method of submucosal laser destruction for chronic anal fissure in comparison with traditional electrosurgical techniques.

Material and methods. The study included 722 patients with chronic anal fissure, which were divided into two groups depending on the method of surgical treatment performed. Patients of the first group underwent excision of the anal fissure using an electrocoagulator and devulsion of the sphincter under spinal anesthesia.

Patients of the second group underwent submucosal laser destruction of the anal fissure with sphincter devulsion under intravenous anesthesia or under tumescent anesthesia. Laser radiation of a diode device with a wavelength of 1.56 μm was used, the power was 8 or 10 W.

Results. The laser technique significantly reduces postoperative pain syndrome, the risk of postoperative complications, and the likelihood of disease recurrence compared to the traditional surgical method of excision.

Conclusion. The technique has technical simplicity, the possibility of an individual approach to the patient, has no restrictions on the clinical manifestations of the disease.

Design: retrospective study.

Keywords:anal fissure; laser destruction; divulsion

References

1.     Agapov M.A., Aliev F.Sh., Achkasov S.I., Bashankaev B.N., Biryukov O.M., Blagodarny L.A., et al. Anal fissure. Clinical guidelines. Koloproktologiya [Coloproctology]. 2021; 20 (4): 10–21. DOI: https://doi.org/10.33878/2073-7556-2021-20-4-10-21  (in Russian)

2.     Wienert V., Raulf F., Mlitz H. Anal Fissure: Symptoms, Diagnosis and Therapies. Springer, 2017. P. 63.

3.     Khryukin R.Yu., Kostarev I.V., Arslanbekova K.I., Nagudov M.A., Zharkov E.E. Botulinum toxin type A and lateral subcutaneous sphincterotomy in the treatment of chronic anal fissure with sphincter spasm. What to choose? (systematic literature review and meta-analysis). Koloproktologiya [Coloproctology]. 2020; 19 (2): 113–28. DOI: https://doi.org/10.33878/2073-7556-2020-19-2-113-128  (in Russian)

4.     Soichi T., Matsuda Y., Matsuda D., Kawakami K., et al. Functional outcome after surgery for anal fissure in Japan. Nippon Daicho Komonbyo Gakkai Zasshi. 2016; 69 (10): 540–8. DOI: https://doi.org/10.3862/jcoloproctology.69.540  

5.     Stewart D.B. Sr, Gaertner W., Glasgow S. Clinical practice guideline for the management of anal fissures. Dis Colon Rectum. 2017; 60 (1): 7–14.

6.     Walfisch S., Silberstein E. Balloon anal Dilatation for Anal Fissure. Ben-Gurion University of the Negev, January 1998.

7.     Santander C., Gisbert J.P., Moreno R. Usefulness of manometry to select patients with anal fissure for controlled anal dilatation. Rev Esp Enferm Dig. 2010; 102 (12): 691–7. DOI: https://doi.org/10.4321/S1130-01082010001200003  

8.     Pinsk I., Czeiger D., Lichtman D., Reshef A. The long-term effect of standardized anal dilatation for chronic anal fissure on anal continence. Ann Coloproctol. 2020; 37 (2): 115–9. DOI: https://doi.org/10.3393/ac.2020.03.16  

9.     Bagdasaryan L.K., Titov A.Yu., Bagdasaryan S.L., Abdulzhalilov M.M. Conusodivulsion in the surgical treatment of anal fissures. Koloproktologiya [Coloproctology]. 2016; (1S): 14. (in Russian)

10. Hancke E., Schwaner S. Chronische Analfissur – Operative Behandlung mit Analdilatation, Exzision der Analfissur versus laterale Sphinkterotomie. Coloproctology. 2003; 25 (2): 95–105. DOI: https://doi.org/10.1007/s00053-003-5091-7  

11. Marby M., Alexander-Williams J., Buchmann P., Arabi Y. A randomized controlled trial to compare anal dilatation with lateral subcutaneous sphincterotomy for anal fissure. Dis Colon Rectum. 1979; 22 (5): 308–11. DOI: https://doi.org/10.1007/BF02609311  

12. Renzi A., Izzo D., Di Sarno G., Talento P. Clinical, manometric, and ultrasonographic results of pneumatic balloon dilatation vs lateral internal sphincterotomy for chronic anal fissure: a prospective, randomized, controlled trial. Dis Colon Rectum. 2008; 51 (1): 121–7. DOI: https://doi.org/10.1007/s10350-007-9162-7  

13. Kumar D., Negi A., Kumar N., Pandey A. A prospective, randomize study of comparison of lateral internal sphincterotomy versus Lord’s anal dilatation in chronic anal fissure. Int Surg J. 2018; 5 (3): 1026. DOI: https://doi.org/10.18203/2349-2902.isj20180824  

14. Bashir R. Comparison between Lateral Internal Sphincterotomy And aLord’s Operation for Chronic Anal Fissure. July 2022. DOI: https://doi.org/10.47489/pszmc8453636569  

15. Hareesh G.S.R., Somangurthy P. Comparative study of manual anal dilatation and lateral internal anal sphincterotomy in the treatment of acute anal fissure. Int Surg J. 2019; 6 (6): 2022–7. DOI: https://doi.org/10.18203/2349-2902.isj20192359  

16. Fateh S.H., Darvish Shafighi S., Norouzi A., Kalantari M. Outcome of laser therapy in patients with anal fissure. Hamdan Med J. 2016; 9 (1). DOI: https://doi.org/10.7707/hmj.423  

17. Denisenko V.L. Comparative assessment of the quality of life of patients in the early postoperative and rehabilitation periods after excision of the anal fissure and its laser vaporization. Khirurgiya. Vostochnaya Evropa [Surgery. Eastern Europe]. 2022.; 11 (4): 537–45. DOI: https://doi.org/10.34883/PI.2022.11.4.019  (in Russian)

18. Gupta Kamal. Role of lasers in anal fissures. In: Lasers in Proctology. Springer, 2022: 299–318. DOI: https://doi.org/10.1007/978-981-19-5825-0_18

All articles in our journal are distributed under the Creative Commons Attribution 4.0 International License (CC BY 4.0 license)