Utilization of a Combined Procedure for Hemorrhoids and Chronic Anal Fissure Is Safe and Feasible
Abstract
1. Introduction
2. Materials and Methods
2.1. Study Design and Patient Inclusion
2.2. Peri-Operative Management and Surgical Technique
2.3. Outcome Measures
2.4. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Data Availability Statement
Conflicts of Interest
References
- Roelandt, P.; Bislenghi, G.; Coremans, G.; De Looze, D.; Denis, M.; De Schepper, H.; Dewint, P.; Geldof, J.; Gijsen, I.; Komen, N.; et al. Belgian consensus guideline on the management of anal fissures. Acta Gastroenterol. Belg. 2024, 87, 304–321. [Google Scholar] [CrossRef] [PubMed]
- Davids, J.S.; Ridolfi, T.J. Hemorrhoids. In The ASCRS Textbook of Colon and Rectal Surgery; Steele, S.R., Hull, T.L., Hyman, N., Maykel, J.A., Read, T.E., Whitlow, C.B., Eds.; Springer Nature: Cham, Switzerland, 2022. [Google Scholar]
- Chong, P.S.; Bartolo, D.C. Hemorrhoids and fissure in ano. Gastroenterol. Clin. N. Am. 2008, 37, 627–644. [Google Scholar] [CrossRef] [PubMed]
- Stewart, D.B.; Gaertner, W.; Glasgow, S.; Migaly, J.; Feingold, D.; Steele, S.R. Clinical Practice Guideline for the Management of Anal Fissures. Dis. Colon Rectum 2017, 60, 7–14. [Google Scholar] [CrossRef] [PubMed]
- Davis, B.R.; Lee-Kong, S.A.; Migaly, J.; Feingold, D.L.; Steele, S.R. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Hemorrhoids. Dis. Colon Rectum 2018, 61, 284–292. [Google Scholar] [CrossRef] [PubMed]
- van Tol, R.R.; Kleijnen, J.; Watson, A.J.M.; Jongen, J.; Altomare, D.F.; Qvist, N.; Higuero, T.; Muris, J.W.M.; Breukink, S.O. European Society of ColoProctology: Guideline for haemorrhoidal disease. Color. Dis. 2020, 22, 650–662. [Google Scholar] [CrossRef] [PubMed]
- Tsikitis, V.L.; Marecik, S. Anal Fissure and Anal Stenosis. In The ASCRS Textbook of Colon and Rectal Surgery; Steele, S.R., Hull, T.L., Hyman, N., Maykel, J.A., Read, T.E., Whitlow, C.B., Eds.; Springer Nature: Cham, Switzerland, 2022. [Google Scholar]
- Cross, K.L.R.; Brown, S.R.; Kleijnen, J.; Bunce, J.; Paul, M.; Pilkington, S.; Warren, O.; Jones, O.; Lund, J.; Goss, H.J.; et al. The Association of Coloproctology of Great Britain and Ireland guideline on the management of anal fissure. Color. Dis. 2023, 25, 2423–2457. [Google Scholar] [CrossRef] [PubMed]
- Jin, J.Z.; Bhat, S.; Park, B.; Hardy, M.-O.; Unasa, H.; Mauiliu-Wallis, M.; Hill, A.G. A systematic review and network meta-analysis comparing treatments for anal fissure. Surgery 2022, 172, 41–52. [Google Scholar] [CrossRef] [PubMed]
- Leong, A.F.; Husain, M.J.; Seow-Choen, F.; Goh, H.S. Performing internal sphincterotomy with other anorectal procedures. Dis. Colon Rectum 1994, 37, 1130–1132. [Google Scholar] [CrossRef] [PubMed]
- Kanda, Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transpl. 2013, 48, 452–458. [Google Scholar] [CrossRef] [PubMed]
- Emile, S.H.; Youssef, M.; Elfeki, H.; Thabet, W.; El-Hamed, T.M.A.; Farid, M. Literature review of the role of lateral internal sphincterotomy (LIS) when combined with excisional hemorrhoidectomy. Int. J. Color. Dis. 2016, 31, 1261–1272. [Google Scholar] [CrossRef] [PubMed]
- Kanellos, I.; Zacharakis, E.; Christoforidis, E.; Angelopoulos, S.; Kanellos, D.; Pramateftakis, M.G.; Betsis, D. Usefulness of lateral internal sphincterotomy in reducing postoperative pain after open hemorrhoidectomy. World J. Surg. 2005, 29, 464–468. [Google Scholar] [CrossRef] [PubMed]
- Kanellos, I.; Angelopoulos, S.; Zacharakis, E.; Kanellos, D.; Pramateftakis, M.; Blouhos, K.; Betsis, D. Stapled haemorrhoidopexy for haemorrhoids in combination with lateral internal sphincterotomy for fissure-in-ano. Eur. Surg. Res. 2005, 37, 317–320. [Google Scholar] [CrossRef] [PubMed]
- Gefen, R.; Handal, A.; Ben-Ezra, C.; Parnasa, S.Y.; Mizrahi, I.; Abu-Gazala, M.; Pikarsky, A.J.; Shussman, N. A patient tailored approach to the surgical treatment of hemorrhoids leads to equal satisfaction following hemorrhoidectomy, stapled hemorrhoidopexy or a combination of both. Langenbecks Arch. Surg. 2023, 408, 233. [Google Scholar] [CrossRef] [PubMed]
Factors | n | % | |
---|---|---|---|
Patients | 56 | ||
Age (Mean ± SD) | 46.9 ± 13.7 | ||
Sex | Female | 29 | 51.8 |
Male | 27 | 48.2 | |
Type of Procedure for Hemorrhoids | Excisional hemorrhoidectomy | 36 | 64.3 |
Stapled hemorrhoidopexy | 12 | 21.4 | |
Combined hemorrhoidopexy with excision of residual hemorrhoids | 8 | 14.3 | |
Type of Anesthesia | General | 40 | 71.4 |
Spinal | 16 | 28.6 | |
Short Term Complications | 2 | 3.6 | |
Follow-up Time (Median, Range) | 45.4 months (21.5–86.4) |
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Gefen, R.; Handal, A.; Ben-Ezra, C.; Parnasa, S.Y.; Mizrahi, I.; Abu-Gazala, M.; Pikarsky, A.J.; Shussman, N. Utilization of a Combined Procedure for Hemorrhoids and Chronic Anal Fissure Is Safe and Feasible. Surgeries 2025, 6, 85. https://doi.org/10.3390/surgeries6040085
Gefen R, Handal A, Ben-Ezra C, Parnasa SY, Mizrahi I, Abu-Gazala M, Pikarsky AJ, Shussman N. Utilization of a Combined Procedure for Hemorrhoids and Chronic Anal Fissure Is Safe and Feasible. Surgeries. 2025; 6(4):85. https://doi.org/10.3390/surgeries6040085
Chicago/Turabian StyleGefen, Rachel, Adham Handal, Carmel Ben-Ezra, Shani Y. Parnasa, Ido Mizrahi, Mahmoud Abu-Gazala, Alon J. Pikarsky, and Noam Shussman. 2025. "Utilization of a Combined Procedure for Hemorrhoids and Chronic Anal Fissure Is Safe and Feasible" Surgeries 6, no. 4: 85. https://doi.org/10.3390/surgeries6040085
APA StyleGefen, R., Handal, A., Ben-Ezra, C., Parnasa, S. Y., Mizrahi, I., Abu-Gazala, M., Pikarsky, A. J., & Shussman, N. (2025). Utilization of a Combined Procedure for Hemorrhoids and Chronic Anal Fissure Is Safe and Feasible. Surgeries, 6(4), 85. https://doi.org/10.3390/surgeries6040085