Assessment Of Prevalence, Features Of Pathogenesis, Clinical Course And Treatment Outcomes Of Chronic Anal Fissure In Patients With Rectocele

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Natalia V. Оleynik, Arina P. Krivсhikоva, Andrey L.Yarosh, Natalia N. Bratisheva, Andrey V. Naumov

Abstract

The problem of surgical treatment of chronic anal fissures is relevant because of the high frequency of its occurrence in patients
with constipation. Despite the fact that difficulties with defecation is the main symptom of rectocele, and rectocele, in turn, is a
common disease in women, so far the role of this pathology in the occurrence of anal fissures has not been studied. The aim of the
research was to evaluate the prevalence, pathogenesis, clinical course, and results of treatment of chronic anal fissures combined
with rectocele. A retrospective study based on an analysis of 2,045 cases report forms of patients operated on for anal fissures at
the Belgorod Regional Coloproctology Center for 20 years (2000-2019) was performed. In 692 patients, which was 33.8%, it was
combined with rectocele. The study showed different mechanisms of anal fissure formation in patients with rectocele, compared
with patients who had anal fissure and normal configuration of the pelvic floor, as well as a less favorable course of the long-term
postoperative period. The patients with anal fissures in combination with rectocele are 1.8 times more likely to have anterior
localization of cracks and 3.4 times more likely to have double localization, compared with patients with fissures and normal pelvic
floor configuration. Due to the weakness of the pelvic floor muscle system in this category of patients, an increase in the tone of
the anal sphincter is 1.7 times less frequent. However, the healing time of wounds after excision of fissures is longer, on average, by
14 days, and relapses of the disease are noted 3.4 times more often.

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