Lateral internal sphincterotomy is still crucial to heal hypertonic chronic anal fissure and normalize the internal anal sphincter tone? Is V-en Y plastic a valuable alternative?

INTRODUCTION: The role of augmented internal anal sphincter (IAS) tone in the genesis of chronic anal fissure (CAF) is still unclear. Lateral internal sphincterotomy (LIS) is the most employed surgical procedure, aiming to reduce the IAS tone leaving a permanent anatomical alteration and it is burdened by high risk post-operative anal incontinence (AI). The aim of this work was to evaluate if the pre-operative manometric alterations of CAFs with hypertonic IAS would normalize after sphincter preserving surgical procedure. METHODS: We enrolled 108 consecutive patients affected by idiopathic and non-recurrent CAF undergone fissurectomy and anoplasty with V-Y cutaneous flap advancement and pha…

Giant pseudocyst of the abdominal wall following incisional ventral hernia repair: an extremely rare clinical entity. Report of a case

Il “gold standard” per il trattamento dei laparoceli è l’intervento chirurgico con impiego di protesi, nonostante questo approccio sia gravato da numerose complicanze post-operatorie; tra queste possiamo annoverare le pseudocisti giganti della parete addominale, tale evenienza risulta ancora molto rara e la sua eziopatogenesi riamane non chiara. In questo lavoro descriviamo il caso clinico di una paziente di 36 anni, diabetica ed obesa, precedentemente sottoposta a taglio cesareo e riparazione di laparocele con posizionamento di protesi in sede soprafasciale. La paziente si è presentata presso i nostri ambulatori per la comparsa di un gonfiore asintomatico a livello della fossa iliaca sinis…

Ansia e depressione in bambini e adolescenti con epilessia del lobo frontale e temporale: risultati preliminari di uno studio caso-controllo

Long term outcomes of fissurectomy and anoplasty for chronic anterior anal fissure without hypertonia: low recurrences and continence conservation

Aetiopathogenesis of Chronic Anal Anterior Fissure (CAAF) remains poorly understood. Some anatomical, clinical and functional features suggest that pathophysiology may be linked to a reduced anal canal pressure. LIS appear illogical as a treatment for CAAF and the employ of techniques aiming to save the integrity of the sphincterial system appears more sensible. The aim of this study was to evaluate 5 years results of fissurectomy and anoplasty with cutaneous V-Y advancement flap in patients affected by CAAF without IAS hypertonia.We enrolled 20 women, affected by idiopathic and non-recurrent CAAF without hypertonic IAS. All patients were followed up for 5 years after surgery with evaluatio…