How to Optimize Surgical Treatment of Chronic Anal Fissure Combined With Rectocele In Women

Abstract

V.F. Kulik& 1086;vsky, N.V. & 1054;leynik, A.P. Kriv& 1089;hik& 1086;va, M.S. Aleni& 1089;heva, Yarosh A.L..

Anal fissure is a common condition in women of all ages. The most common causes are childbirth and constipation. Anal fissure is often diagnosed in women with rectocele. Unsatisfactory results of surgical treatment of chronic anal fissures in patients with rectocele enforce to continue the investigations for the optimal solution of this problem.
The aim of research was to improve the results of surgical treatment of chronic anal fissures in patients with rectocele.
Materials and Methods. In 2015-2019, on the basis of the Surgery Department of Belg?¾r?¾d Nati?¾nal ResearÑ�h University and Coloproctology Department of Belgorod St. Joasaph's Hospital, we conducted a comparative assessment of the results of surgical treatment of 74 patients with recocele and chronic anal fissure, who underwent isolated surgery of anal fissure excision (1st group, n=35) and anal fissure excision, combined with posterior colporrhaphy in the 2nd group (n=39). According to indications for spasm of the internal anal sphincter, in patients of both groups internal lateral sphincterotomy was performed.
Results. Local pain syndrome in the anus area in the first day after the operation in all patients was intensive. Starting from the 2nd day, the pain in the area of the vaginal wound of the patients of the 2nd group almost did not bother them. On 3±1 day of the postoperative period, pain during and after defecation in patients of the 2nd group were less pronounced than in patients of the 1st group. Starting from 4th day, patients of the 2nd group had pain only during and after defecation for 15-25 minutes. In patients of the 1st group, the pain syndrome was more intense and persisted for 5-7 days of the postoperative period. Hyperemia and edema of the mucosa, infiltration of the wound edges and fibrin layers on the wound in patients of the 2nd group were less pronounced and decreased faster. The anal wound bleeding at the end of the first defecation was noted in 18 (46.2%) patients in the 2nd group and stopped in 2-3 days. In the 1st group patients wound bleeding during first defecation was registered in 25 (71.4%) (P=0.855). It persisted in comparison with the 2nd group of patients for an average of 2-3 days longer. Moreover, in 5 patients it was noted on 10-12 days after surgery. The results of cytological examination of smears from the surface of wounds showed more favorable course of the wound process in patients of the 2nd group. By the 3rd day in smears from wounds taken from patients of both groups there is a large number of neutrophils. In the 2nd group of patients, phagocytosis in almost all was complete with an average intensity of 82.5%. In the 1st group of patients, phagocytosis in 36.5% was incomplete. The intensity of phagocytosis was on average 58.3%. On 4-5 days in cytograms of patients of the 2nd group there were signs of repair - the appearance of single-core histiocytic cells: profibroblasts, fibroblasts. On day 6-8 connective tissue cells appear: fibrocytes and epithelial cells. In most patients of group 1 27 (77.1%) granulocytic and macrophagal reactions lasted on average for 3-4 days longer. Cellular signs of wound repair appeared later, on 6th-8thdays after surgery.
Conclusion. Analysis of the results of surgical treatment of anal fissures by its excision and simultaneous pelvic floor plastic surgery showed better results than in patients who had surgery for anal fissure only.