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Aim The study aimed to evaluate outcome at 1 year of one- and two-stage fistulotomy for anal fistula in a large group of patients. Method A prospective multicentre observational study was designed to include patients with anal fistula treated by one- or two-stage fistulotomy. Data were collected using a self-administered questionnaire before surgery, during healing and at 1 year after surgery. Results Group A (133 patients) with a low anal fistula underwent a one-stage fistulotomy. The median Wexner scores before and after surgery were 1.0 (0−11) and 2.0 (0−18) ( P = 0.032) and the median Vaizey scores were 2.0 (0−14) and 3.0 (0−21) ( P = 0.055). The Wexner scores and percentage of patients before and after fistulotomy were as follows: 0−5: 88%, 86%; 6−10: 10.7%, 10.7%; 11−15: 1.0%, 2.6%; and 16−20: 0%, 2%. Eighty-seven per cent of the patients were satisfied. Group B (62 patients) underwent two-stage fistulotomy for a high transsphincteric fistula. The Wexner scores and percentage of patients before the first stage and 1 year after the second stage were as follows: 0−5: 86%, 66%; 6−10: 4.5%, 20%; 11−15: 9%, 11%; and 16−20: 0%, 2%. The median Wexner scores before the first stage and after the second stage were 1 (0−14) vs 4 (0−19) ( P < 0.001), and the median Vaizey scores were 1.5 (0−11) vs 4 (0−20) ( P < 0.001). Eighty-eight per cent of the patients were satisfied. Conclusion Low transsphincteric anal fistula can be treated by fistulotomy without clinically significant continence disturbance. Treating high transsphincteric anal fistulae with two-stage fistulotomy is followed by mild continence disturbance. Satisfaction rates were high. [ABSTRACT FROM AUTHOR]

Aim An evaluation was performed of the 1-year outcome of open haemorrhoidectomy (Milligan and Morgan alone or with posterior mucosal anoplasty [the Leopold Bellan procedure]). Method A prospective, multicentre, observational study included all patients having a planned haemorrhoidectomy from January 2007 to June 2008. Data were collected before surgery, and at 3 months and 1 year after surgery. Patients assessed their anal symptoms and quality of life ( SF-36). Results Six-hundred and thirty-three patients (median age = 48 years, 56.5% women) underwent haemorrhoidectomy either by the Milligan and Morgan procedure alone ( n = 231, 36.5%) or together with the Leopold Bellan procedure (posterior mucosal anoplasty) for resection of a fourth haemorrhoid ( n = 345, 54.5%), anal fissure ( n = 56, 8.9%) or low anal fistula ( n = 1, 0.16%). The median healing time was 6 weeks. Early complications included urinary retention ( n = 3), bleeding ( n = 11), local infection ( n = 7) and faecal impaction ( n = 9). At 1 year, the main complications included skin tags ( n = 2) and anal stenosis ( n = 23). There were three recurrences requiring a second haemorrhoidectomy. On a visual analogue scale, anal pain at 1 year had fallen from a median of 5.5/10 before treatment to 0.1/10 (p < 0.001), anal discomfort from 5.5/10 to 0.1/10 ( P < 0.001) and the Knowles-Eckersley-Scott Symptom ( KESS) constipation score from 9/45 to 6/45 ( P < 0.001). The median Wexner score for anal incontinence was unchanged (2/20). De-novo anal incontinence (a Wexner score of >5) affected 8.5% of patients at 1 year, but preoperative incontinence disappeared in 16.7% of patients with this symptom. All physical and mental domains of quality of life significantly improved, and 88% of patients were satisfied or very satisfied. Conclusion Complications of open haemorrhoidectomy were infrequent. Anal continence was not altered. Comfort and well-being were significantly improved at 1 year after surgery. Patient satisfaction was high despite residual anal symptoms. [ABSTRACT FROM AUTHOR]

Aim Internal sphincterotomy is the standard surgical treatment for chronic anal fissure, but is frequently complicated by anal incontinence. Fissurectomy is proposed as an alternative technique to avoid sphincter injury. We describe 1-year outcomes of fissurectomy. Method This was a prospective, multicentre, observational study. All patients with planned surgery for chronic anal fissure were included and had fissurectomy. Data were collected before surgery, at healing, and 1 year after fissurectomy. Patient self-assessed anal symptoms and quality of life (using the 36-item short-form health survey [SF-36] questionnaire). Presurgical and postsurgical variables were compared using the Wilcoxon signed-rank test for paired samples. Results Two-hundred and sixty-four patients were included (median age, 45 years; 52% women). Anoplasty was associated with fissurectomy in 83% of the 257 documented cases. The main complications were urinary retention ( n = 3), local infection ( n = 4) and faecal impaction ( n = 1). Healing was achieved in all patients at a median of 7.5 weeks after surgery. No recurrence occurred. At 1 year, 210 (79%) questionnaires were returned. Median anal pain had dropped from 7.3/10 to 0.1/10 ( P < 0.001), anal discomfort had decreased from 5.0/10 to 0.1/10 ( P < 0.001) and the Knowles-Eckersley-Scott Symptom constipation score had decreased from 9/45 to 5/45 ( P < 0.001). There was a nonsignificant increase in the Wexner anal incontinence score, from 1/20 to 2/20. De-novo clinically significant anal incontinence (Wexner score > 5) affected 7% of patients at 1 year, but presurgical incontinence had disappeared in 15% of patients. All SF-36 domains significantly improved. Anoplasty did not impact any result. Conclusion Given its high rate of healing and low rate of de-novo anal incontinence, fissurectomy with anoplasty is a valuable sphincter-sparing surgical treatment for chronic anal fissure. [ABSTRACT FROM AUTHOR]