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Surgery is sometimes necessary to relieve patients with chronic anal fissure. It consists of resecting the edges of the fissure to make a wound larger than the initial fissure, in order to obtain healing. Thus, the edges of the wound do not stick together and the healing is done from the bottom of the wound. This procedure is widely performed in France with results that seem satisfactory. In addition to resection of the fissure, a partial closure of the wound can be associated with a small flap of rectal mucosa which is sutured with a few absorbable stitches: this is anoplasty.
There is some debate as to whether to perform a fissurectomy alone or to complement it with an anoplasty to accelerate healing. The choice of technique performed depends on the training and habits of the operators but the results of fissurectomy alone and fissurectomy with anoplasty have never been compared. In the medical-surgical proctology department of the Groupe Hospitalier Paris Saint-Joseph (GHPSJ), both procedures are performed. The investigators therefore decided to compare the after-effects of fissurectomies alone with those of fissurectomies with anoplasty that were performed in the department in 2019. The choice between the 2 procedures is left exclusively to the discretion of the operator. The criteria for choice between the two patient populations are not different.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Patients operated by fissurectomy | |||
| Patients operated by fissurectomy with anoplasty |
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| Measure | Description | Time Frame |
|---|---|---|
| Compare the effectiveness of the two techniques on the disappearance of pain related to anal fissure | Difference between the 2 groups in terms of percent of patients free of pain at Day 15 postoperatively | Day 15 |
| Measure | Description | Time Frame |
|---|---|---|
| Compare the two techniques for the rate of complications | Difference between the 2 groups of patients at Day 15 post-operative in terms of complication rate | Day 15 |
| Compare the two techniques for the healing rate |
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Inclusion Criteria:
Exclusion Criteria:
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Patients will be selected based on procedure coding:
The follow-up of the patients corresponds to the usual follow-up of the patients within the proctology unit (consultation at Day 15, Day 30 post-operative and then every month until complete healing).
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Groupe Hospitalier Paris Saint Joseph | Paris | Île-de-France Region | 75014 | France |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 36973105 | Result | Skoufou M, Lefevre JH, Fels A, Fathallah N, Benfredj P, de Parades V. Fissurectomy with mucosal advancement flap anoplasty: The end of a dogma? J Visc Surg. 2023 Oct;160(5):330-336. doi: 10.1016/j.jviscsurg.2023.03.003. Epub 2023 Mar 25. |
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Difference between the 2 groups of patients at Day 15 post-operative in terms of healing rate
| Day 15 |
| Compare the two techniques for the rate of non-healing | Difference between the 2 groups of patients at Day 15 post-operative in terms of non-healing rate | Day 15 |
| Compare the two techniques for the recurrence rate | Difference between the 2 groups of patients at Day 15 post-operative in terms of revision rate | Day 15 |
| Compare the two techniques for the rate of revision surgery | Difference between the 2 groups of patients at D15 postoperatively in terms of revision rate | Day 15 |
| Search for predictive factors of failure of each technique | Uni- and multivariate analyses to identify risk factors for failure for each technique | Day 15 |