Authors
Lavreshin P.M.1, Gobedzhishvili V.K.1, Gorbunkov V.Ya.1, Efimov A.V.2, Zhernosenko A.O.2, Machukova M.N.1
1 Stavropol state medical university, Stavropol
2 City Clinical Hospital №3, Tuapse
Abstract
Chronic anal fissure (CAF) is diagnosed in 2–2.5% of the world’s population over the age of 18 years. Surgical treatment of patients with CAF in 35.7% of operated patients leads to insufficiency of the anal sphincter, in 1.6% of patients — to the formation of fistulas and cicatricial contractures of the anus, in 11.7% of patients relapses of the disease occur.
Purpose of the study. To determine the risk factors for the transition of an acute anus fissure (AAF) to a chronic one (CAF).
Methods. The results of examination of 97 patients with anus fissure are presented: 54 (55.7%) patients with AAF, 43 (44.3%) — with CAF. There were 65 women (67%), men — 32 (33%). The age of the patients ranged from 18 to 72 years. In all patients, concomitant diseases, the acetylating ability of the organism were studied, and the titer of antibodies to the antigenic complex from the scar tissue was determined in the enzyme immunoassay. The contractility of the anal sphincter was studied using the S4402 sphincterometer. The study of fragments of scar tissue obtained after excision of a chronic fissure of the anus was carried out by capillary electrophoresis on a chip for protein analysis using the Experion System.
Results. To predict the development of pathological scarring, it is necessary to study the dynamics of changes in the concentrations of acute phase inflammation proteins in the peripheral blood of AAF patients. Increased sphincter tone and dysfunction of the obturator apparatus of the rectum are important in the development, progression and chronicity of an acute fissure of the anus. Risk factors for the transition of AAF to CAF are concomitant diseases, high acetylator activity of the body.
Conclusion. Revealing the causes of chronicity of AAF will allow to optimize treatment tactics in patients with AAF and improve the immediate and long-term results of their treatment.
Keywords: fissure of the anus; forecasting criteria; treatment; excessive scarring.
References
1. Groshilin VS, Horon’ko YUV, Bashankaev BN, et al. Opyt ispol’zovaniya individual’nogo podhoda v lechenii anal’nyh treshchin. Hirurgiya. ZHurnal im. N.I. Pirogova. 2019; 8(2): 32-39. (In Russ).
2. Ul’yanov AA, Solomka AYA, Achkasov EE, et al. Hronicheskaya anal’naya treshchina: etiopatogenez, diagnostika, lechenie. Hirurgiya. ZHurnal im. N.I. Pirogova. 2018; 11: 89-95. (In Russ).
3. Stewart DB, Gaertner W, Glasgow S, et al. Clinical Practice Guideline for the Management of Anal Fissures. Dis Colon Rectum. 2017; 60(1): 7-14.
4. Zagryadskiy EA. Anoplasty in the treatment of chronic anal fissure. Koloproktologiya. 2017; 3(61): 23-23. (In Russ).
5. Motie MR, Hashemi P. Chronic Anal Fissure: A Comparative Study of Medical Treatment Versus Surgical Sphincterotomy. Acta Med Iran. 2016; 54(7): 437-440.
