ANOPLASTY AND LATERAL INTERNAL SPHINCTEROTOMY FOR CHRONIC ANAL FISSURE (systematic review and meta-analysis)

Abstract

INTRODUCTION: Lateral internal sphincterotomy (LIS) is considered the ‘gold standard’ therapy for chronic anal fissure (CAF).  Advantages of LIS over other surgical techniques include higher rate of healing and lower risk of fissure recurrence. However, this procedure is associated with a high risk of anal sphincter insufficiency (ASI) in the postoperative period. Anal advancement flap (AAF) is an alternative surgical procedure for CAF, which requires the use of local flaps. Anal advancement flap is associated with a significantly lower risk of anal incontinence.AIM: to compare short-term and long-term outcomes of аnal advancement flap and lateral internal sphincterotomy in patients with chronic anal fissure.METHODS: a systematic review and meta-analysis of studies comparing outcomes of Anal advancement flap and lateral internal sphincterotomy was conducted. We evaluated the following parameters: the rate of epithelialization, the rate of anal sphincter insufficiency, and the rate of postoperative complications. We carried out statistical analysis using the Review Manager software (Review Manager 5.3.)RESULTS: the systematic review included four studies that presented the results of 278 patients. Compared with LIS, the odds for healing after AAF were 63% lower (OR=0.37; CI=0.19;0.74; P<0.005). We found no significant differences in the rate of postoperative complications (OR=1.43; CI=0.54;3.78; P=0,47). Compared with AAF, the odds for anal incontinence after LIS were 94% greater (OR=0.06; CI=0.01;0.37; P=0,002).CONCLUSION: both lateral internal sphincterotomy and аnal advancement flap are effective in curing CAF. However, considering the ambiguity and poor quality of data from the studies comparing these procedures, a high risk of bias for comparison groups and heterogeneity of the studies, one should interpret the results with caution; the aforementioned limitations dictate the need for further research.