Background: After the failure of conservative therapy, the most effective surgical treatment for chronic anal fissures (CAFs) is lateral internal sphincterotomy. However, the choice of the procedure must be always evaluated carefully due to the risk of long-term anal continence impairment. The aim of the present study is to report the outcomes of fissurectomy with or without associated anoplasty.

Methods: This study is a single-center retrospective study including patients with CAFs in whom conservative medical and non-medical treatments failed and who underwent fissurectomy with or without anoplasty from January 2015 to June 2023. Fecal continence, pain, and complications were assessed using specific questionnaires and scores.

Results: Overall, 475 patients [280 males (58.9%)] with CAF underwent fissurectomy, with (n = 392; 82.5%) or without (n = 83; 17.5%) anoplasty. The majority of them (n = 379; 79.8%) had a posterior fissure. The mean follow-up was 49.9 months ± 26.13 months, with a minimum of 1 year, showing no intraoperative complications and a 4.2% postoperative complication rate. Missed healing occurred in 7.15% of patients at 6 months of follow-up, with higher recurrence and sphincterotomy rates in posterior fissures (p = 0.04). Cleveland Clinic Incontinence Scores were higher in patients who underwent anoplasty (p = 0.002). Interestingly, anoplasty led to a significant decrease in visual analogue scale (VAS) scores (p < 0.001), compared with those who did not undergo the procedure, with a consequent faster recovery.

Conclusion: Our study showed that fissurectomy, whether performed with or without anoplasty, was a highly effective surgical option for treating CAFs, achieving an overall success rate of 92.8% without significant impairment of continence and with a low complication rate. Further randomized prospective trials are needed to confirm this finding. Interestingly, fissurectomy with anoplasty seems to allow for better short-term outcomes in terms of postoperative pain and recovery time compared with fissurectomy alone.

Keywords: Anal fissures; Anoplasty; Cronic anal fissures; Fissurectomy; Surgical treatment.

© 2025. The Author(s).

背景： 在保守治疗失败后，慢性肛裂（CAF）最有效的手术治疗方法是内括约肌切开术。然而，由于长期肛门失禁的风险，必须仔细评估选择该程序的必要性。本研究旨在报告进行瘘管切除术伴或不伴有肛门成形术的效果。

方法： 这项研究是一项单中心回顾性研究，包括2015年1月至2023年6月期间保守治疗失败并接受瘘管切除术伴或不伴有肛门成形术的慢性肛裂患者。使用特定问卷和评分评估排便失禁、疼痛及并发症。

结果： 总共475名患者（280名为男性，占58.9%）接受了瘘管切除术，其中有392名患者（占82.5%）伴有肛门成形术。大多数患者（n = 379；占79.8%）患有后侧裂口。平均随访时间为49.9个月±26.13个月，最短为一年，显示无手术并发症及术后并发症发生率为4.2%。在六个月的随访中，有7.15%患者的愈合失败，在后方裂口中观察到更高的复发率和内括约肌切开术率（p = 0.04）。克利夫兰失禁评分在进行肛门成形术的患者中较高（p = 0.002）。有趣的是，与未接受该手术的患者相比，肛门成形术显著降低了视觉模拟量表（VAS）评分（p

结论： 我们的研究表明，无论是进行瘘管切除伴或不伴有肛门成形术，都是治疗慢性肛裂的一种非常有效的手术选择，在不影响排便失禁和并发症发生率低的情况下实现了总体92.8%的成功率。需要进一步的随机前瞻性试验来确认这一发现。有趣的是，与单独进行瘘管切除相比，瘘管切除伴肛门成形术似乎在术后疼痛及恢复时间方面取得了更好的短期结果。

关键词： 肛裂；肛门成形术；慢性肛裂；瘘管切除术；外科治疗。