Anocutaneous Advancement Flap Surgery Outperforms Fissurectomy in Chronic Anal Fissures

Overview

This retrospective observational study compared anocutaneous advancement flap (AAF) surgery with fissurectomy (FIS) for chronic anal fissures (CAF) unresponsive to conservative treatment. AAF demonstrated superior outcomes with higher rates of symptom resolution and wound healing at 1 month postoperatively, fewer early complications, and lower recurrence rates over a minimum 5-year follow-up.

Background

Chronic anal fissures are defined by persistence beyond 8 weeks and secondary morphological changes. While lateral internal sphincterotomy (LIS) is the standard surgical treatment, it carries a risk of anal incontinence. Fissurectomy preserves sphincter function but often results in prolonged healing times. Anocutaneous advancement flap surgery offers primary wound closure to potentially accelerate healing and reduce complications, especially in patients with recurrent fissures or low anal resting pressure. This study evaluates AAF as a first-line surgical option irrespective of patient gender, anal tone, or fissure location.

Data Highlights

Key Findings

• Anocutaneous advancement flap surgery resulted in 89.5% of patients being symptom-free at 1 month postoperatively compared to 53.8% after fissurectomy alone.
• Complete wound healing at 1 month was significantly higher in the AAF group (87.7%) versus the FIS group (42.3%).
• Early postoperative complications occurred in 7.7% of AAF patients compared to 26.9% in the FIS group.
• Late complications between 1 month and 5 years were less frequent after AAF (2.4%) than after FIS (11.5%).
• Anal incontinence symptoms were rare and comparable between groups, with 0.9% in AAF and none in FIS.
• Recurrence rates of chronic anal fissure within 5 years were significantly lower after AAF (3.5%) compared to FIS (19.2%).

Clinical Implications

Anocutaneous advancement flap surgery should be considered a preferred first-line surgical treatment for chronic anal fissures unresponsive to conservative therapy, as it offers faster symptom resolution and wound healing with fewer complications and lower recurrence rates. This technique preserves sphincter integrity and minimizes the risk of incontinence, making it suitable irrespective of patient gender or anal tone.

Conclusion

Anocutaneous advancement flap surgery outperforms fissurectomy alone in treating chronic anal fissures by providing superior healing, reduced complications, and lower recurrence, supporting its use as a primary surgical approach.

References

1. Eisenhammer et al. 2023 -- Anocutaneous Advancement Flap Surgery Outperforms Fissurectomy in Treating Chronic Anal Fissures