Uncovering the Link Between Pre-Surgery Constipation and the Success of Surgery for Chronic Anal Fissure

Abstract

Introduction

Chronic anal fissure is a common condition affecting all ages. Surgical intervention is often necessary for severe cases. Recent studies indicate that the success of surgical procedures for chronic anal fissures is closely linked to the patient's bowel movements. Constipation can impede healing and increase the risk of complications post-surgery. This article investigates the correlation between pre-surgery constipation and the efficacy of fissure surgery, while also examining its impact on treatment outcomes.

Methods

We conducted a retrospective cohort study. Patients who underwent surgery for chronic anal fissures were evaluated for age, complaints, anorectal examination characteristics, and anatomical localization of fissures. The Rome IV criteria were used to diagnose functional constipation associated with anal fissures. We investigated the relationship between pre-surgery constipation and treatment success.

Results

Baseline constipation was detected in 21.4% of patients. At the 6-month follow-up, 28 patients failed to fully recover, but baseline constipation did not affect treatment success (p = 0.306). Additionally, Among the 28 patients with pre-surgery constipation, 15 still experienced constipation, while 8 of the 103 patients without pre-surgery constipation developed constipation postoperatively.

Conclusions

Our study found that the success of fissure surgery treatment was not affected by constipation. These results suggest that the theory of constipation and hard stool may be inadequate to fully explain the causes and success of surgical treatment for anal fissures. Other theories, such as high basal internal sphincter pressure and related ischemia, should be considered.

Keywords

chronic anal fissure - treatment success - surgery - constipation - lateral internal sphincterotomy

Presentation at a Meeting

Nil.

Data Availability Statement

The data presented in this study are available on request from the corresponding author. The data are not publicly available due to ethical restrictions.

Ethical Considerations

This retrospective cohort study involving human participants was approved by the Ethics Committee of the University of Health Sciences, Umraniye Training and Research Hospital (Document No: 268, Decision No: 289, Date: September 5, 2024). The study was conducted in accordance with the national research committee's guidelines and the principles outlined in the Declaration of Helsinki and its later amendments or comparable ethical standards.

Patient Declaration of Consent Statement

This study does not contain identifying patient information. Specific written informed consent for this study was not required due to its retrospective design. However, all patients and/or their legal guardians had previously signed a general informed consent form allowing the anonymous use of their data for research, education, and quality improvement purposes.

Authors' Contributions

All named authors contributed to the clinical care of the patients, data collection, drafting and revising of the manuscript, and approval of the final version of the article.

Publikationsverlauf

Eingereicht: 02. August 2024

Angenommen: 22. Mai 2025

Artikel online veröffentlicht:
26. Juni 2025

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