Conservative Management of Chronic Anal Fissure. Results of a Case Series at 2-years Follow-up and Proposition of a New Classification.

BACKGROUND: Anal fissure is a common proctological condition that is usually defined as an anodermal ulcerative process starting from the posterior commissure to the dentate line. The objective of this study was to evaluate the resolution rate of anal fissure through the use of conservative management in patients grouped according to our newly proposed classification. A secondary purpose was to quantify the recurrence rates at 2-years follow-up in each group. METHODS: A retrospective analysis was carried out on patients in our general database. Diagnosis was based on symptoms, clinical observation, anal manometry and transanal ultrasounds. After application of inclusion and exclusion criteria, patients were assigned to different groups. Follow-up was carried out at 3, 6, 12 and 24 months. RESULTS: A total of 136 patients (54 female and 82 male) were included in the statistical analysis. At the end of the treatment period, all patients in groups 1 and 2 had a complete resolution of illness and a normal basal sphincterial tone, while those in groups 3 and 4 had a higher rate of recurrence at the 2-year follow-up. CONCLUSION: Based on our series, we propose a definitive non-surgical management for all group 1 and 2 anal fissures according to our protocol. For groups 3 and 4, we recommend a primary non-surgical approach with follow-up. This was a retrospective study and further randomized controlled studies will be necessary to confirm our results.

Laparoscopic Adjustable Gastric Banding (LAGB) Plus Anterior Fundoplication Versus LAGB Alone: A Prospective Comparative Study.

BACKGROUND: Laparoscopic adjustable gastric banding (LAGB) is a well-established and effective bariatric procedure, whose outcomes can be compromised by the slippage and the following removal of the band; the association between LAGB and gastric plication has recently been proved as a successful treatment for morbid obesity. The aim of this prospective randomized study was to compare weight loss and slippage rate between LAGB and LAGB plus anterior fundoplication. METHODS: From January 2012 to May 2012, a total of 40 patients were allocated to undergo either LAGB (group A, n=20) or LAGB plus anterior fundoplication (group B, n=20). Data on the operative time, complications, hospital stay, total weight loss percentage (%TWL), percentage of excess weight loss (%EWL), and improvement of comorbidities were collected at 6, 12, and 36 months of follow-up. RESULTS: All procedures were completed laparoscopically, and no significant difference of mean operative time was found between the 2 groups. The mean hospital stay was longer in group B than in group A (2.3±0.8 vs. 1.4±0.7 d, P<0.005). Greater weight loss was found in group B rather than in group A at 6, 12, and 36 months. Obesity related comorbidities improved in both groups. Number of band regulations and slippage rate were lower in group B. CONCLUSIONS: Our experience shows that 36 months after surgery LAGB plus anterior fundoplication increases weight loss and reduces the slippage rate.