Modern Methods of Surgical Treatment of Anal Fissures

Abstract

Currently, in the structure of coloproctological pathology, anal fissure occupies the third place, second only to hemorrhoids and colitis in prevalence [4]. According to the data of patients seeking treatment, the incidence of anal fissure is 20–23 cases per 1000 adults [6], while the proportion in the structure of colorectal diseases is, according to various authors, from 8.5 to 16%. More than half of the patients are of working age, while women get sick 1.5-1.8 times more often than men [4]. A triad of symptoms is characteristic of a fissure: pain, sphincterospasm, and poor blood flow during defecation [5]. Caused by a crack, the pain is so intense that patients lose their ability to work, sleep,

Manual uncontrolled divulsion of the anal sphincter and simple fissurectomy, which have been proposed for many years to date as monomethods for the treatment of anal fissure, do not meet the criteria for a reliable cure.

Purpose: to evaluate the options for optimal surgical treatment of anal fissures.

Material and methods. Our study was based on the analysis of the treatment of 107 patients with chronic fissure operated in 2010-2015. in the proctology department of the clinic of the Andijan State Medical Institute, which is the clinical base of the Department of General Surgery. Among them there were 67 (62.6%) women and 40 (37.4%) men aged 18 to 60 years. The patients were examined. The anamnesis was carefully collected, laboratory, digital rectal examination and endoscopic examinations were carried out at the pre-hospital stage. Of these, in 90 people (92.8%), endoscopic examination was performed under local infiltration anesthesia due to severe pain and concomitant sphincterospasm. Laboratory research methods make it possible to assess the functional state of internal organs, which influenced the choice of the method of anesthesia (local infiltration or spinal). Endoscopic instrumental research methods make it possible to make a topical diagnosis in almost 100% of cases and exclude or confirm the presence of concomitant proctological diseases (proctosigmoiditis, oncopathology, hemorrhoids, etc.). Since one of the leading places in the pathogenesis of anal fissure belongs to sphincterospasm, its condition, as well as volitional tension of all portions of the external sphincter, was assessed by digital rectal examination.