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Mucosal vs. cutaneous advancement flaps for the treatment of chronic anal fissures: a randomized clinical trial

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Abstract

Purpose

The aim of this study was to compare two surgical treatment methods for chronic anal fissures (CAF), mucosal advancement flap anoplasty (MAFA) and cutaneous advancement flap anoplasty (CAFA).

Methods

A randomized, blinded clinical trial was conducted on patients with CAF refractory to medical treatment referred to a tertiary-level hospital between January 2021 and December 2022. The patients were assigned to two groups by block randomization and were compared in terms of outcome, pain reduction, and complications.

Results

There were 30 patients (male to female ratio 2:3, median age 42 years [range 25–59 years]). Both techniques reduced anal pain significantly (p = 0.001); however, there were no significant differences between MAFA and CAFA groups in recurrence, duration of healing, postoperative pain, and postoperative bleeding. No patient suffered from fecal incontinence (Wexner score = 0) or flap necrosis postoperatively. Only two patients in the MAFA group (1 and 3 months after surgery) and one patient in the CAFA group (2 months after surgery) had recurrence (total recurrence rate = 10%, healing rate = 90%). All of the patients were satisfied with their surgical results.

Conclusion

Mucosal and cutaneous anal advancement flap techniques are effective and comparable surgical procedures for the treatment of chronic anal fissures with minimal complications, fast healing process, and minimal postoperative pain and complications.

Clinical trial ID

IRCT20120129008861N4 (www.irct.ir).

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Data availability

Data is available upon request to the corresponding author.

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Funding

Authors have received no funds for this study.

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Authors and Affiliations

  1. Division of Colorectal Surgery, Department of Surgery, Imam-Khomeini Hospital Complex, Tehran University of Medical Sciences, Keshavarz Blvd, Tehran, 1419733141, Iran

    M. S. Najafi, A. Kazemeini, S. M. Meshkati Yazd, M. Dashtkuhi, S. M. Ahmadi Tafti, B. Behboudi, M. S. Fazeli, A. Keshvari & M. R. Keramati

  2. Colorectal Research Center, Tehran University of Medical Sciences, Tehran, Iran

    M. S. Najafi, A. Kazemeini, S. M. Meshkati Yazd, M. Dashtkuhi, S. M. Ahmadi Tafti, B. Behboudi, M. S. Fazeli, A. Keshvari & M. R. Keramati

Authors
  1. M. S. Najafi
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  2. A. Kazemeini
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  3. S. M. Meshkati Yazd
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  4. M. Dashtkuhi
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  5. S. M. Ahmadi Tafti
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  6. B. Behboudi
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  7. M. S. Fazeli
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  8. A. Keshvari
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  9. M. R. Keramati
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Contributions

All authors contributed substantially to this paper.

Corresponding author

Correspondence to M. R. Keramati.

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Authors have no conflict of interest.

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Informed consent to participate in the study was taken from all participants.

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This study has been approved by the ethics committee of Tehran University of Medical Sciences.

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Najafi, M.S., Kazemeini, A., Meshkati Yazd, S.M. et al. Mucosal vs. cutaneous advancement flaps for the treatment of chronic anal fissures: a randomized clinical trial. Tech Coloproctol 27, 891–896 (2023). https://doi.org/10.1007/s10151-023-02810-5

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  • DOI: https://doi.org/10.1007/s10151-023-02810-5

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