DOI: https://doi.org/10.22263/2312-4156.2023.4.51
V.L. Denisenko1, N.V. Denisenko2, Yu.M. Gain3
Laser vaporization in the treatment of chronic anal fissure
1Vitebsk Regional Clinical Specialized Center, Vitebsk, Republic of Belarus
2Vitebsk State Order of Peoples’ Friendship Medical University, Vitebsk, Republic of Belarus
3Belarusian Medical Academy of Postgraduate Education, Minsk, Republic of Belarus
Vestnik VGMU. 2023;22(4):51-56.
Abstract.
Objectives. To evaluate the effectiveness of using laser vaporization in the treatment of chronic anal fissure.
Material and methods. A study was conducted, which included 259 patients with chronic anal fissure. In the main group, patients underwent vaporization of chronic anal fissure by means of laser with a power of 10 W and a wavelength of 1560 nm with a dosed lateral sphincterotomy. In the control group, excision of the anal fissure was used. The life quality of patients was assessed on the sf-36 scale, the average length of hospital stay was assessed as well.
Results. The average hospital stay was 4.1±2 in the main group, and 9.3±1.9 bed-days in the control group. The majority of patients in the control group had low life quality indicators for all analyzed domains, while in patients of the main group, physical and mental health indicators were significantly higher both in the early and long-term postoperative period.
Conclusions. The use of laser vaporization in the treatment of chronic anal fissure is a modern method that allows to cure a patient with this pathology within a short time and without any complications.
Keywords: anal fissure, laser vaporization, laser destruction, sphincterospasm, lateral sphincterotomy, mucosal-submucosal flap.
References
1. Beaty JS, Shashidharan M. Anal Fissure. Clin Colon Rectal Surg. 2016 Mar;29(1):30-7. doi: http://dx.doi.org/10.1055/s-0035-1570390
2. Stewart DB, Gaertner W, Glasgow S, Migaly J, Feingold D, Steele SR. Clinical practice guideline for the management of anal fissures. Dis Colon Rectum. 2017 Jan;60(1):7-14. doi: http://dx.doi.org/10.1097/DCR.0000000000000735
3. Boland PA, Kelly ME, Donlon NE, Bolger JC, Larkin JO, Mehigan BJ, et al. Management options for chronic anal fissure: a systematic review of randomised controlled trials. Int J Colorectal Dis. 2020 Oct;35(10):1807-15. doi: http://dx.doi.org/10.1007/s00384-020-03699-4
4. Sobrado Júnior CW, Bacchi Hora JA, Sobrado LF, Guzela VR, Nahas SC, Cecconello I. Anoplasty with skin tag flap for the treatment of chronic anal fissure. Rev Col Bras Cir. 2019 Aug;46(3):e20192181. doi: http://dx.doi.org/10.1590/0100-6991e-20192181
5. Marti L, Post S, Herold A, Schwandner O, Hetzer F, Strittmatter B, et al. S3-Leitlinie: Analfissur. AWMF-Registriernummer:081-010. Coloproctology. 2020;42:90-196. doi: http://dx.doi.org/10.1007/s00053-020-00448-7
6. Holzgang M, Jayne D. Lateral internal sphincterotomy (LIS)-still top gun in chronic anal fissure treatment? Coloproctology. 2020;42:478-84. doi: http://dx.doi.org/10.1007/s00053-020-00454-9
7. D'Orazio B, Sciumé C, Famà F, Bonventre S, Martorana G, Corbo G, et al. Surgical sphincter saving approach and topical nifedipine for chronic anal fissure with hypertonic internal anal sphincter. Chirurgia (Bucur). 2020 Sept-Oct;115(5):585-594. doi: http://dx.doi.org/10.21614/chirurgia.115.5.585
8. Shelygin YuA, Blagodarnyi LA, red. Coloproctology Handbook. Moscow, RF: GEOTAR-Media; 2014. 608 р. (In Russ.)
9. Arroyo A, Montes E, Calderón T, Blesa I, Elía M, Salgado G, et al. Treatment algorithm for anal fissure. Consensus document of the Spanish Association of Coloproctology and the Coloproctology Division of the Spanish Association of Surgeons. Cir Esp. 2018 May;96(5):260-7. doi: http://dx.doi.org/10.1016/j.ciresp.2018.02.007
10. Brady JT, Althans AR, Neupane R, Dosokey EMG, Jabir MA, Reynolds HL, et al. Treatment for anal fissure: is there a safe option? Am J Surg. 2017 Oct;214(4):623-8. doi: http://dx.doi.org/10.1016/j.amjsurg.2017.06.004
11. Collins EE, Lund JN. A review of chronic anal fissure management. Tech Coloproctol. 2007 Sep;11(3):209-23. doi: http://dx.doi.org/10.1007/s10151-007-0355-9
12. Gil J, Luján J, Hernández Q, Gil E, Salom MG, Parrilla P. Screening for the effectiveness of conservative treatment in chronic anal fissure patients using anorectal manometry. Int J Colorectal Dis. 2010 May;25(5):649-54. doi: http://dx.doi.org/10.1007/s00384-010-0885-x
13. Wald A, Bharucha AE, Limketkai B, Malcolm A, Remes-Troche JM, Whitehead WE, et al. ACG clinical guideline: management of benign anorectal disorders. Am J Gastroenterol. 2021 Oct;116(10):1987-2008. doi: http://dx.doi.org/10.14309/ajg.0000000000001507
14. Andjelkov K, Sforza M, Barisic G, Soldatovic I, Hiranyakas A, Krivokapic Z. Novel method for treatment of chronic anal fissure: adipose-derived regenerative cells – a pilot study. Colorectal Dis. 2017 Jun;19(6):570-5. doi: http://dx.doi.org/10.1111/codi.13555
15. Witte ME, Klaase JM, Koop R. Fissurectomy combined with botulinum toxin A injection for medically resistant chronic anal fissures. Colorectal Dis. 2010 Jul;12(7):e163-9. doi: http://dx.doi.org/10.1111/j.1463-1318.2009.02063.x
16. Patti R, Famà F, Barrera T, Migliore G, Di Vita G. Fissurectomy and anal advancement flap for anterior chronic anal fissure without hypertonia of the internal anal sphincter in females. Colorectal Dis. 2010 Nov;12(11):1127-30. doi: http://dx.doi.org/10.1111/j.1463-1318.2009.02068.x
Information about authors:
V.L. Denisenko – Doctor of Medical Sciences, professor, chief physician of the Vitebsk Regional Clinical Specialized Center,
e-mail: Этот адрес электронной почты защищён от спам-ботов. У вас должен быть включен JavaScript для просмотра. – Valery L. Denisenko;
N.V. Denisenko – the fifth-year medical student, Vitebsk State Order of Peoples’ Friendship Medical University;
Yu.M. Gain – Doctor of Medical Sciences, professor, vice-rector for scientific affairs of Belarusian Medical Academy of Postgraduate Education.
