Anal fissure is identified as a common bowel problem. Classic symptoms include pain upon bowel movement and bleeding. In the earlier times, it was believed that anal fissure is a result of mechanical trauma – passing out hard stool that scratches the anal lining and eventually causes a tear. More studies were done to find out the possible causes of anal fissures.
Nowadays, it has been proven that the main cause of anal tear is the increased tone of the anal sphincters. Surgical treatment such as lateral internal sphincterectomy can weaken the anal sphincter muscles and decrease its tone or contraction state. This has been the main surgical option for chronic anal fissures. Chronic anal fissures are anal tears that have not healed despite conservative medical treatment.
Although lateral internal sphincterectomy have showed high success rates, there are still some people who are not satisfied with the results. Advancement flap coverage can be a good surgical treatment option for them. Advancement or dermal flap coverage is a popular surgical procedure in the world of cosmetic surgery. It involves harvesting healthy tissue and replacing the damaged ones. Nowadays, dermal flaps are not just used in cosmetic surgery. They are becoming popular as treatment for anal fissure.
Good candidates for advancement flap coverage are people with high risk for fecal incontinence. These include the diabetics, multiparous women, and those with irritable bowel syndromes. It is also a good treatment option for people who have undergone lateral internal sphicterectomy but still have recurrent anal fissure. It is usually the next option for those who have had unsuccessful lateral internal sphincterectomy surgeries. People who have undergone multiple surgical treatments for their anal tear are also good candidates for dermal flap coverage.
Advancement flap coverage involves replacing chronic non-healing tissue with healthier vascularized tissue. The healthy tissue are harvested from the other parts of the body. The well-vascularized tissue will be able to initiate good blood flow to the area and prevent recurrence of non-healing tissues. This procedure lessens the incidence of internal sphincter damage and fecal incontinence.
Compared to lateral internal sphincterectomy, no incision is made in the internal sphincter muscles in the application of advancement flap. This will preserve the integrity of the anal sphincter muscles. This can save the patient from possible risk of fecal incontinence due to anal sphincter muscle damage. Elderly people who have high risk for fecal incontinence due to weak anal muscles can safely undergo the procedure. Further trauma in their internal sphincter muscles may worsen their condition. The colorectal surgeons perform this kind of procedure. They are highly trained in various colorectal surgeries and medical treatment.
When choosing a surgical treatment for chronic anal fissure, it is best to have a clear conversation with a colorectal surgeon. The indication of undergoing an advancement flap coverage may depend on the person’s medical history. A surgical treatment option that is successful for one person may not be the best option for another. Understanding the risks and complications associated with the procedure may also help the patient in choosing the best treatment option.
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