71 results on '"Fissure in Ano"'
Search Results
2. Reply to 'Pelvic floor dysfunction and chronic anal fissure: a dog chasing its tail'
- Author
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D A, van Reijn-Baggen, H W, Elzevier, R C M, Pelger, and I J M, Han-Geurts
- Subjects
Humans ,Anal Canal ,Fissure in Ano ,Pelvic Floor ,Fecal Incontinence - Published
- 2022
3. Pelvic floor dysfunction and chronic anal fissure: a dog chasing its tail
- Author
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R, Pietroletti, S, Valiyeva, and M, Goglia
- Subjects
Tail ,Dogs ,Anal Canal ,Animals ,Humans ,Fissure in Ano ,Pelvic Floor ,Fecal Incontinence - Published
- 2022
4. Bilateral versus unilateral botulinum toxin injections for chronic anal fissure: a randomised trial.
- Author
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Pilkington, S. A., Bhome, R., Welch, R. E., Ku, F., Warden, C., Harris, S., Hicks, J., Richardson, C., Dudding, T. C., Knight, J. S., King, A. T., Mirnezami, A. H., Beck, N. E., Nichols, P. H., and Nugent, K. P.
- Subjects
- *
FISSURE in ano , *BOTULINUM toxin , *INJECTIONS , *VISUAL analog scale , *CLINICAL trials , *THERAPEUTICS - Abstract
Background: Botulinum toxin injected into the internal anal sphincter is used in the treatment of chronic anal fissure but there is no standardised technique for its administration. This randomised single centre trial compares bilateral (either side of fissure) to unilateral injection.Methods: Participants were randomised to receive bilateral (50 + 50 units) or unilateral (100 units) Dysport® injections into the internal anal sphincter in an outpatient setting. Injection-related pain assessed by visual analogue scale was the primary outcome measure. Secondary outcomes were healing rate, fissure pain, incontinence, and global health scores.Results: Between October 2008 and April 2012, 100 patients with chronic anal fissure were randomised to receive bilateral or unilateral injections. Injection-related pain was comparable in both groups. There was no difference in healing rate. Initially, there was greater improvement in fissure pain in the bilateral group but at 1 year the unilateral group showed greater improvement. Cleveland Clinic Incontinence score was lower in the unilateral group in the early post-treatment period and global health assessment (EuroQol EQ-VAS) was higher in the unilateral group at 1 year.Conclusions: Injection-related pain was similar in bilateral and unilateral injection groups. Unilateral injection was as effective as bilateral injections in healing and improving fissure pain without any deterioration in continence. [ABSTRACT FROM AUTHOR]
- Published
- 2018
- Full Text
- View/download PDF
5. The REALISE score: a new statistically validated scoring system to assess the severity of anal fissures
- Author
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L. Spazzafumo, D. F. Altomare, Marcella Rinaldi, Rigers Dibra, Arcangelo Picciariello, Giuseppe Trigiante, Rita Laforgia, P. Lobascio, and A. Pezzolla
- Subjects
Anal fistula ,medicine.medical_specialty ,Scoring system ,Visual analogue scale ,Quality of life ,medicine ,Humans ,Repeatability ,Prospective Studies ,Anal fissure ,business.industry ,Gastroenterology ,Reproducibility of Results ,medicine.disease ,Reliability ,Colorectal surgery ,Treatment Outcome ,Inter-/intraobserver agreement ,Chronic Disease ,Physical therapy ,Quality of Life ,Surgery ,Original Article ,Obstructed defecation ,Fissure in Ano ,medicine.symptom ,business ,Abdominal surgery - Abstract
Background Anal fissure (AF) is a common, painful disease that strongly affects patients’ quality of life, however, no scoring system to assess the severity of AF is available in the literature. The aim of this study was to set up and validate a reliable scoring system to quantify the severity of AF, to be used in prospective trials comparing the efficacy and the outcomes of surgical or medical treatments. Methods The study was conducted on patients with acute or chronic AF and a control group in a tertiary centre for coloproctology in June 2020–September 2020. Two researchers independently carried out a structured interviewer-led questionnaire at two different time points (T1/T2). The questionnaire consisted of five items selected according to the most commonly reported symptoms for AF: the item pain, was scored from 0 to 10 using a visual analogue scale, and quality of life, duration of pain, use of painkillers, and bleeding were scored from 1 to 5 using Likert-scale questions. The scoRing systEm for AnaL fIsSurE (REALISE) score was the sum of the points. Patients with AF and a control group of patients with haemorrhoids, anal fistula, or obstructed defecation syndrome entered the study. Main outcome measures were reliability, inter-/intraobserver agreement, and repeatability. Results One hundred and fifty well-matched patients (75 with AF and 75 controls) were enrolled. A significant difference was found between the mean REALISE score for patients with AF and controls (p r = 0.99). The coefficient of repeatability was 1.45 in T1 and 1.18 in T2. Conclusions The REALISE score may have an important role in the assessment and management of AF, in grading the severity of AF and comparing results of different treatments.
- Published
- 2021
6. A systematic review and meta-analysis of the treatment of anal fissure.
- Author
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Nelson, R., Manuel, D., Gumienny, C., Spencer, B., Patel, K., Schmitt, K., Castillo, D., Bravo, A., and Yeboah-Sampong, A.
- Subjects
- *
FISSURE in ano , *SPHINCTERECTOMY , *CALCIUM antagonists , *HETEROGENEITY , *THERAPEUTICS ,THERAPEUTIC use of nitroglycerin - Abstract
Background: Anal fissure has a very large number of treatment options. The choice is difficult. In an effort to assist in that, choice presented here is a systematic review and meta-analysis of all published treatments for anal fissure that have been studied in randomized controlled trials. Methods: Randomized trials were sought in the Cochrane Controlled Trials Register, Medline, EMBASE and the trials registry sites clinicaltrials.gov and who/int/ictrp/search/en. Abstracts were screened, full-text studies chosen, and finally eligible studies selected and abstracted. The review was then divided into those studies that compared two or more surgical procedures and those that had at least one arm that was non-surgical. Studies were further categorized by the specific interventions and comparisons. The outcome assessed was treatment failure. Negative effects of treatment assessed were headache and anal incontinence. Risk of bias was assessed for each study, and the strength of the evidence of each comparison was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Results: One hundred and forty-eight eligible trials were found and assessed, 31 in the surgical group and 117 in the non-surgical group. There were 14 different operations described in the surgical group and 29 different non-surgical treatments in the non-surgical group along with partial lateral internal sphincterotomy (LIS). There were 61 different comparisons. Of these, 47 were reported in 2 or fewer studies, usually with quite small patient samples. The largest single comparison was glyceryl trinitrate (GTN) versus control with 19 studies. GTN was more effective than control in sustained cure (OR 0.68; 95% CI 0.63-0.77), but the quality of evidence was very poor because of severe heterogeneity, and risk of bias due to inadequate clinical follow-up. The only comparison to have a GRADE quality of evidence of high was a subgroup analysis of LIS versus any medical therapy (OR 0.12; CI 0.07-0.21). Most of the other studies were downgraded in GRADE due to imprecision. Conclusions: LIS is superior to non-surgical therapies in achieving sustained cure of fissure. Calcium channel blockers were more effective than GTN and with less risk of headache, but with only a low quality of evidence. Anal incontinence, once thought to be a frequent risk with LIS, was found in various subgroups in this review to have a risk between 3.4 and 4.4%. Among the surgical studies, manual anal stretch performed worse than LIS in the treatment of chronic anal fissure in adults. For those patients requiring surgery for anal fissure, open LIS and closed LIS appear to be equally efficacious, with a moderate GRADE quality of evidence. All other GRADE evaluations of procedures were low to very low due mostly to imprecision. [ABSTRACT FROM AUTHOR]
- Published
- 2017
- Full Text
- View/download PDF
7. Percutaneous tibial nerve stimulation (PTNS): an alternative treatment option for chronic therapy resistant anal fissure
- Author
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Ursula Aho Fält, Salma Butt, Emelie Nilsson, Sara Strandberg, Martin Lindsten, Antoni Zawadzki, Mari Dahlberg, and Louis Banka Johnson
- Subjects
Male ,Therapy resistant ,medicine.medical_specialty ,Chronic anal fissure ,Sacral nerve stimulation ,Wound healing ,Anal Canal ,Percutaneous tibial nerve stimulation ,Medicine ,Humans ,Treatment resistant ,Anal fissure ,business.industry ,Gastroenterology ,Middle Aged ,musculoskeletal system ,medicine.disease ,Alternative treatment ,Colorectal surgery ,Surgery ,Treatment Outcome ,Electrical stimulation ,Chronic Disease ,Transcutaneous Electric Nerve Stimulation ,Original Article ,Female ,Fissure in Ano ,Tibial Nerve ,business ,Constipation ,Abdominal surgery - Abstract
Background The aim of the present study was to evaluate percutaneous tibial nerve stimulation (PTNS) for treatment resistant chronic anal fissure. Methods Consecutive patients with chronic anal fissure were treated with neuromodulation via the posterior tibial nerve between October 2013 and January 2014. Patients had PTNS for 30 min on 10 consecutive days. All patients had failed conventional medical treatment. The visual analogue scale (VAS) score, St. Marks score, Wexner’s constipation score, Brief Pain Inventory (BPI-SF), bleeding and mucosal healing were evaluated before treatment, at termination, after 3 months, and then yearly for 3 years. Results Ten patients (4 males and 6 females; mean age 49.8 years) were identified but only 9 were evaluated as one patient’s fissure healed before PTNS was started. At 3-year follow-up, fissures had remained completely healed in 5 out of 9 patients. All patients stopped bleeding and were almost completely pain-free at 3 years (VAS p = 0.010) and pain relief improved from 50% at completion to 90% at 3 years. The patients’ Wexner constipation scores improved significantly (p = 0.007). Conclusions In this small series, PTNS enhanced healing of chronic anal fissure and reduced pain and bleeding with an associated improvement in bowel function.
- Published
- 2019
8. SICCR web-educational colorectal meeting 'Hemorrhoids and fissures': Congress report
- Author
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D. Passannanti, F. La Torre, G Milito, D Telesco, and Fabio Gaj
- Subjects
medicine.medical_specialty ,business.industry ,General surgery ,Gastroenterology ,MEDLINE ,Anal Canal ,Anal canal ,medicine.disease ,Hemorrhoids ,Colorectal surgery ,Fissure in ano ,Congress Report ,medicine.anatomical_structure ,medicine ,Humans ,Surgery ,Fissure in Ano ,business ,Colorectal Neoplasms ,Abdominal surgery - Published
- 2021
9. Prospective multicenter observational trial on the safety and efficacy of LEVORAG Emulgel in the treatment of acute and chronic anal fissure.
- Author
-
Digennaro, R., Pecorella, G., Manna, S., Alderisio, A., Pascalis, B., Pennisi, D., Santangelo, G., Pezzolla, F., Racalbuto, A., Serra, G., Pulvirenti D'Urso, A., and Altomare, D.
- Subjects
- *
DRUG efficacy , *FISSURE in ano , *PAIN , *VISUAL analog scale , *WOUND healing - Abstract
Background: Anal fissure (AF) is a common cause of anal pain with a tendency not to heal spontaneously because of ischemia of the anoderm caused by sphincter spasm. Lateral internal sphincterotomy, while very effective, can cause fecal incontinence and chemical sphincterotomy by application of cream may have discouraging side effects and/or low efficacy. The aim of this prospective multicenter study was to evaluate the safety and effectiveness of a new medical treatment based on Emulgel cream, with emollient, soothing and protective agents, on AF healing. Methods: Consecutive patients with AF treated in nine coloproctology units during 6 months entered the study on topical treatment with Levorag Emulgel (THD S.p.A Correggio (RE), Italy). Before treatment, they had a proctologic examination and pain was measured using a visual analog scale. THD Levorag Emulgel was applied every 12 h for 40 days. Monitoring was scheduled at 10, 20 and 40 days. At time 0 and at the end of treatment, patients underwent anorectal manometry, if possible. Results: Two hundred eighty-four AF patients were recruited (171 acute fissures). Complete healing was achieved in 47.9 % of the cases, an improvement in 31.0 % (global efficacy 78.9 %). In patients with acute fissure, the rate of efficacy was 89.4 % (complete healing: 64.3 %, improvement: 25.1 %), in those with chronic fissure the rate of efficacy was 62.8 % (complete healing: 23 %, improvement: 39.8 %), p < 0.001. Pain and resting anal pressure decreased significantly after treatment. Conclusions: Treatment with THD Levorag Emulgel proved to be effective for the reepithelization of AF and the reduction of pain in the short term in about 80 % of patients. [ABSTRACT FROM AUTHOR]
- Published
- 2015
- Full Text
- View/download PDF
10. Evaluation of practice patterns of chemodenervation for anal fissure of the ASCRS young surgeons
- Author
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J. S. Mizell, Karen L. Sherman, Karen Zaghiyan, Nelya Melnitchouk, and Anuradha R. Bhama
- Subjects
Surgeons ,Anal fissure ,medicine.medical_specialty ,Practice patterns ,business.industry ,General surgery ,Gastroenterology ,Anal Canal ,Nerve Block ,medicine.disease ,Chemodenervation ,Colorectal surgery ,Chronic Disease ,medicine ,Humans ,Surgery ,Fissure in Ano ,business ,Abdominal surgery - Published
- 2020
11. High-dose versus low-dose botulinum toxin in anal fissure disease
- Author
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R. George, C. Ciampa, G. Punch, Daniel L. Chan, Praveen Ravindran, and S. I. White
- Subjects
Adult ,Male ,medicine.medical_specialty ,Botulinum Toxins ,Time Factors ,Multivariate analysis ,medicine.medical_treatment ,Acetylcholine Release Inhibitors ,Urology ,03 medical and health sciences ,0302 clinical medicine ,Patient satisfaction ,Recurrence ,medicine ,Humans ,Aged ,Retrospective Studies ,Anal fissure ,business.industry ,Gastroenterology ,Middle Aged ,medicine.disease ,Botulinum toxin ,Colorectal surgery ,Surgery ,medicine.anatomical_structure ,Patient Satisfaction ,Case-Control Studies ,030220 oncology & carcinogenesis ,Chronic Disease ,Sphincter ,Female ,030211 gastroenterology & hepatology ,Fissure in Ano ,business ,Lateral internal sphincterotomy ,Fecal Incontinence ,Abdominal surgery ,medicine.drug - Abstract
There is no consensus on the optimal dosage of botulinum toxin (BT) as a sphincter sparing alternative to lateral internal sphincterotomy for chronic anal fissure. The aim of this study was to assess the long-term efficacy of high-dose BT as well as the presence of incontinence following the treatment of chronic anal fissure at a single institution. A retrospective case–control study was performed at a single institution over a 6-year period (2009–2014). Patients given high-dose (80–100 IU) BT were compared to low-dose (20–40 IU) case controls. Clinical notes were reviewed, and follow-up was carried out via a telephone questionnaire. One hundred and fifty-eight patients were treated with BT injections within the study period (103 high dose; 55 low dose). The mean length of follow-up was 25 months (range 4–52 months). Classic posterior fissures with high anal tone were more prevalent in the low-dose group (40 vs 47%, p = 0.3). Patient satisfaction was higher in the high-dose group (90 vs 78%, p = 0.05). Long-term recurrence (6 months after the last treatment) was also lower (23 vs 53%, p = 0.0001) on multivariate analysis. No long-term incontinence was observed. In this series, the recurrence rate post-BT injection was significantly lower in the high-dose group. There was no long-term incontinence. Further studies are needed to confirm our results.
- Published
- 2017
12. A review of chronic anal fissure management.
- Author
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Collins, E. E. and Lund, J. N.
- Subjects
- *
ANAL diseases , *PATHOLOGICAL physiology , *PROCTOLOGY , *CALCIUM channels , *ION channels , *BOTULINUM toxin - Abstract
Anal fissure management has rapidly progressed in the last 15 years as our understanding of fissure pathophysiology has developed. All methods of treatment aim to reduce the anal sphincter spasm associated with chronic anal fissures. Surgical techniques have been used for over 100 years with success. Lateral internal sphincterotomy remains the surgical treatment of choice for many practitioners. Postoperative impairment of continence remains controversial. Recently, less invasive methods of treatment have been explored. Topical nitrates, calcium channel blockers and botulinum toxin are established treatments. These and other non-surgical treatments are described in this review. Various guidelines and treatment algorithms for anal fissure are also discussed. [ABSTRACT FROM AUTHOR]
- Published
- 2007
- Full Text
- View/download PDF
13. A systematic review and meta-analysis of the treatment of anal fissure
- Author
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B Spencer, A Bravo, K Patel, A Yeboah-Sampong, D Manuel, Richard L. Nelson, K Schmitt, D Castillo, and C Gumienny
- Subjects
medicine.medical_specialty ,Vasodilator Agents ,medicine.medical_treatment ,MEDLINE ,Anal Canal ,Subgroup analysis ,law.invention ,Nitroglycerin ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Sphincterotomy ,Internal medicine ,Humans ,Medicine ,Randomized Controlled Trials as Topic ,Anal fissure ,business.industry ,Gastroenterology ,Calcium Channel Blockers ,medicine.disease ,Colorectal surgery ,Surgery ,030220 oncology & carcinogenesis ,Meta-analysis ,030211 gastroenterology & hepatology ,Fissure in Ano ,business ,Lateral internal sphincterotomy ,Fecal Incontinence ,Abdominal surgery - Abstract
Anal fissure has a very large number of treatment options. The choice is difficult. In an effort to assist in that, choice presented here is a systematic review and meta-analysis of all published treatments for anal fissure that have been studied in randomized controlled trials. Randomized trials were sought in the Cochrane Controlled Trials Register, Medline, EMBASE and the trials registry sites clinicaltrials.gov and who/int/ictrp/search/en. Abstracts were screened, full-text studies chosen, and finally eligible studies selected and abstracted. The review was then divided into those studies that compared two or more surgical procedures and those that had at least one arm that was non-surgical. Studies were further categorized by the specific interventions and comparisons. The outcome assessed was treatment failure. Negative effects of treatment assessed were headache and anal incontinence. Risk of bias was assessed for each study, and the strength of the evidence of each comparison was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. One hundred and forty-eight eligible trials were found and assessed, 31 in the surgical group and 117 in the non-surgical group. There were 14 different operations described in the surgical group and 29 different non-surgical treatments in the non-surgical group along with partial lateral internal sphincterotomy (LIS). There were 61 different comparisons. Of these, 47 were reported in 2 or fewer studies, usually with quite small patient samples. The largest single comparison was glyceryl trinitrate (GTN) versus control with 19 studies. GTN was more effective than control in sustained cure (OR 0.68; 95% CI 0.63–0.77), but the quality of evidence was very poor because of severe heterogeneity, and risk of bias due to inadequate clinical follow-up. The only comparison to have a GRADE quality of evidence of high was a subgroup analysis of LIS versus any medical therapy (OR 0.12; CI 0.07–0.21). Most of the other studies were downgraded in GRADE due to imprecision. LIS is superior to non-surgical therapies in achieving sustained cure of fissure. Calcium channel blockers were more effective than GTN and with less risk of headache, but with only a low quality of evidence. Anal incontinence, once thought to be a frequent risk with LIS, was found in various subgroups in this review to have a risk between 3.4 and 4.4%. Among the surgical studies, manual anal stretch performed worse than LIS in the treatment of chronic anal fissure in adults. For those patients requiring surgery for anal fissure, open LIS and closed LIS appear to be equally efficacious, with a moderate GRADE quality of evidence. All other GRADE evaluations of procedures were low to very low due mostly to imprecision.
- Published
- 2017
14. Different anal pressure profiles in patients with anal fissure.
- Author
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Bove, A., Balzano, A., Perrotti, P., Antropoli, C., Lombardi, G., and Pucciani, F.
- Subjects
- *
ALIMENTARY canal , *CHRONIC diseases , *ANAL fistula , *RECTUM , *DIGESTIVE system diseases , *PATIENTS - Abstract
Background A consistent debate exists about the association between anal fissure and hypertonic anal canal. The aim of this study was to determine if the manometric findings in patients with chronic anal fissures varied according to the topography of the fissure. Patients and methods Seventy-three outpatients (52 men, 71%) with chronic anal fissures and nine healthy volunteers (5 men, 55%) were examined. Patients were classified according to the topography of the anal fissures: posterior midline (group A), anterior midline (group B), and lateral position (group C). We use computerized anorectal manometry to evaluate anal resting pressure, maximal voluntary contraction, recto-anal inhibitory reflex, rectal sensations and rectum compliance. Results In Group A, the mean pressure was higher than that of controls (p<0.05), and the resting pressure 2 cm from anal verge was higher than that of other groups and controls (p<0.05). Normotonic anal canal was found in 49.1% of patients in group A, in 66% of those in group B and in 57.1% of those in group C. Four elderly patients (7%) of group A had a hypotonic anal canal. No differences were found regarding maximal voluntary contraction, recto-anal inhibitory reflex, rectal sensations and rectum compliance between patients and controls. Conclusions Patients with chronic anal fissures may have several anal pressure profiles. The anal canal is often normotonic. Fissures with hypertonic or normo-hypotonic anal canal need different therapies. [ABSTRACT FROM AUTHOR]
- Published
- 2004
- Full Text
- View/download PDF
15. Removal of hypertrophied anal papillae and fibrous anal polyps increases patient satisfaction after anal fissure surgery.
- Author
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Gupta, P. J. and Kalaskar, S.
- Subjects
- *
ANAL diseases , *PATIENT satisfaction , *RADIO frequency , *PREVENTIVE medicine , *PROCTOLOGY , *EVALUATION of medical care - Abstract
Background:. Hypertrophied anal papillae and fibrous anal polyps are frequently found in association with chronic fissure in ano. Usually, no specific attention is given to them and they are considered normal findings. The present prospective study was aimed at determining whether removal of hypertrophied anal papillae and fibrous anal polyps while dealing with chronic fissure in ano confers long-term benefit to patients. Methods:. Between July 1999 and December 2000, 140 patients undergoing anal sphincterotomy were randomized into two groups to have their fibrous polyps and hypertrophied anal papillae either removed by radiofrequency surgery or left intact. After two years, they underwent a detailed interview by an independent, masked investigator. Results:. Overall 84% of patients who had polyp and papilla removal rated the outcome of their surgery as excellent or good in comparison to 58% of controls. The mean satisfaction grading was 9.2 on a visual analogue scale in the treatment group compared to 8.1 in controls (p=0.004). Conclusion:. Removal of hypertrophied anal papillae and fibrous anal polyps should be an essential part of treatment of chronic fissure in ano. Persistence of these structures leaves behind a sense of incomplete treatment, reducing the overall satisfaction on the part of the patient. Radiofrequency procedure is useful in eradication of these concomitant pathologies. [ABSTRACT FROM AUTHOR]
- Published
- 2003
- Full Text
- View/download PDF
16. Fissurectomy with vertical non-full-thickness sphincterotomy for chronic anal fissure
- Author
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H Kusanagi, A Tsunoda, and T. Takahashi
- Subjects
Adult ,Male ,medicine.medical_specialty ,Chronic anal fissure ,MEDLINE ,Anal Canal ,Sphincterotomy ,medicine ,Combined Modality Therapy ,Humans ,Prospective Studies ,Prospective cohort study ,Retrospective Studies ,business.industry ,Gastroenterology ,Retrospective cohort study ,Middle Aged ,Colorectal surgery ,Surgery ,Treatment Outcome ,Chronic Disease ,Full thickness ,Female ,Fissure in Ano ,business ,Abdominal surgery - Published
- 2019
17. Initial experience with a variable width and extreme tip angulation colonoscope.
- Author
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Lara, L., Erim, T., Schneider, A., Palekar, N., Jimenez, B., Murchie, B., Pimentel, R., and Charles, R.
- Subjects
- *
COLONOSCOPY , *FISSURE in ano , *COMPUTED tomography , *EQUIPMENT & supplies - Abstract
The article discusses the technological advancements in the anal fissure treatment process by using screening and surveillance colonoscopies that results in decreased compliance with screening for colon neoplasia. Topics discussed include computerized tomography (CT) colonography, instruments for colonoscopy including ThirdEye and Retroscope from Avantis Medical Systems Inc., and information on retroview colonoscope (RVC) from Pentax America.
- Published
- 2014
- Full Text
- View/download PDF
18. Quality of patient information on the internet for the treatment of anal fistula and anal fissure.
- Author
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Scott, F., Seghal, A., Joshi, H., Yeung, T., and Gosselink, M.
- Subjects
- *
FISSURE in ano , *ANAL fistula , *MEDICAL informatics -- Computer network resources , *QUALITY control of information storage & retrieval systems , *THERAPEUTICS - Abstract
The article discusses the research study conducted which examines the quality of information related to patients of anal fissures and fistulas and its treatment, available on Internet on several search engines including Google, Yahoo and Wikipedia. Topics discussed include information on symptoms, investigations, and treatment option of the diseases, use of DISCERN instrument used to evaluate the quality and reliability of the information available, and variability in quality of information.
- Published
- 2014
- Full Text
- View/download PDF
19. The PNEI holistic approach in coloproctology
- Author
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M. Pescatori, L. C. Pescatori, Maria Pina Dore, Gabrio Bassotti, and V. Podzemny
- Subjects
Adult ,Male ,Control (management) ,Holistic Health ,Holistic health ,Growth hormone ,Enteric Nervous System ,Fissure in ano ,Irritable Bowel Syndrome ,Humans ,Medicine ,Cognitive science ,Wound Healing ,Mechanism (biology) ,business.industry ,Empty Sella Syndrome ,Gastroenterology ,Biofeedback, Psychology ,Middle Aged ,biochemical phenomena, metabolism, and nutrition ,Abdominal Pain ,Psyche ,Growth Hormone ,Immunology ,Female ,Surgery ,Fissure in Ano ,business ,Constipation - Abstract
The psycho-neuroendocrine-immune approach relies on the concept of considering diseases from a holistic point of view: the various components (psyche, nervous system, endocrine system, and immune system) control the diseased organ/apparatus and in turn are influenced by a feedback mechanism. In this article, we will consider the psycho-neuroendocrine-immune approach to coloproctological disorders, by providing clinical cases and discussing them in light of this approach.
- Published
- 2015
20. Prospective multicenter observational trial on the safety and efficacy of LEVORAG® Emulgel in the treatment of acute and chronic anal fissure
- Author
-
R. Digennaro, G. Pecorella, S. La Manna, A. Alderisio, B. De Pascalis, D. Pennisi, G. Santangelo, F. Pezzolla, A. Racalbuto, G. Serra, A. Pulvirenti D’Urso, and D. F. Altomare
- Subjects
Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Chronic anal fissure ,Drug Administration Schedule ,Medicine ,Fecal incontinence ,Humans ,Prospective Studies ,Prospective cohort study ,Pain Measurement ,Anal fissure ,Emollients ,business.industry ,Gastroenterology ,Middle Aged ,medicine.disease ,Chemical sphincterotomy ,Colorectal surgery ,Surgery ,medicine.anatomical_structure ,Treatment Outcome ,Anesthesia ,Acute Disease ,Chronic Disease ,Sphincter ,Original Article ,Female ,Fissure in Ano ,medicine.symptom ,business ,Lateral internal sphincterotomy ,Gels ,Abdominal surgery ,Emulgel cream - Abstract
Background Anal fissure (AF) is a common cause of anal pain with a tendency not to heal spontaneously because of ischemia of the anoderm caused by sphincter spasm. Lateral internal sphincterotomy, while very effective, can cause fecal incontinence and chemical sphincterotomy by application of cream may have discouraging side effects and/or low efficacy. The aim of this prospective multicenter study was to evaluate the safety and effectiveness of a new medical treatment based on Emulgel cream, with emollient, soothing and protective agents, on AF healing. Methods Consecutive patients with AF treated in nine coloproctology units during 6 months entered the study on topical treatment with Levorag® Emulgel (THD S.p.A Correggio (RE), Italy). Before treatment, they had a proctologic examination and pain was measured using a visual analog scale. THD Levorag® Emulgel was applied every 12 h for 40 days. Monitoring was scheduled at 10, 20 and 40 days. At time 0 and at the end of treatment, patients underwent anorectal manometry, if possible. Results Two hundred eighty-four AF patients were recruited (171 acute fissures). Complete healing was achieved in 47.9 % of the cases, an improvement in 31.0 % (global efficacy 78.9 %). In patients with acute fissure, the rate of efficacy was 89.4 % (complete healing: 64.3 %, improvement: 25.1 %), in those with chronic fissure the rate of efficacy was 62.8 % (complete healing: 23 %, improvement: 39.8 %), p
- Published
- 2015
21. SICCR web-educational colorectal meeting "Hemorrhoids and fissures": Congress report.
- Author
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Passannanti D, Telesco D, La Torre F, Milito G, and Gaj F
- Subjects
- Anal Canal, Humans, Colorectal Neoplasms therapy, Fissure in Ano, Hemorrhoids therapy
- Published
- 2021
- Full Text
- View/download PDF
22. Meta-analysis of botulinum toxin injection for chronic anal fissure: healing rates controversies
- Author
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H. A. Rangel-Ríos, N. Salgado-Nesme, O. Vergara-Fernández, and A. Navarro-Navarro
- Subjects
medicine.medical_specialty ,Wound Healing ,Botulinum Toxins ,business.industry ,Gastroenterology ,Chronic anal fissure ,Anal Canal ,Botulinum toxin injection ,Colorectal surgery ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,Text mining ,Treatment Outcome ,030220 oncology & carcinogenesis ,Meta-analysis ,Chronic Disease ,medicine ,Humans ,030211 gastroenterology & hepatology ,Fissure in Ano ,Botulinum Toxins, Type A ,business ,Abdominal surgery - Published
- 2016
23. Treatment of chronic anal fissure with sacral neuromodulation: a pilot study
- Author
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Arantxa Muñoz-Duyos, Laura Lagares-Tena, and S. Delgado-Rivilla
- Subjects
Adult ,Male ,Sacrum ,medicine.medical_specialty ,Chronic anal fissure ,Pilot Projects ,Fissure in ano ,03 medical and health sciences ,0302 clinical medicine ,Humans ,Medicine ,Postoperative Period ,Defecation ,Pain Measurement ,business.industry ,Gastroenterology ,Transcutaneous electric nerve stimulation ,Middle Aged ,Colorectal surgery ,Electrodes, Implanted ,Surgery ,Treatment Outcome ,Sacral nerve stimulation ,030220 oncology & carcinogenesis ,Chronic Disease ,Transcutaneous Electric Nerve Stimulation ,Female ,030211 gastroenterology & hepatology ,Fissure in Ano ,business ,Abdominal surgery - Published
- 2017
24. Decreased blood flow to the posterior anal canal shown during Doppler-guided hemorrhoidal artery ligation explains anodermal ischemia in anal fissure
- Author
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B. Trilling, H. Pflieger, Jean-Luc Faucheron, Centre Hospitalier Universitaire [Grenoble] (CHU), Gestes Medico-chirurgicaux Assistés par Ordinateur (TIMC-IMAG-GMCAO), Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC-IMAG), and Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019])
- Subjects
Hemorrhoidectomy ,medicine.medical_specialty ,[SDV]Life Sciences [q-bio] ,Ischemia ,Anal Canal ,Hemorrhoids ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Decreased blood flow ,Prospective Studies ,Ligation ,ComputingMilieux_MISCELLANEOUS ,Ultrasonography, Interventional ,Anal fissure ,business.industry ,Gastroenterology ,Anal canal ,medicine.disease ,Colorectal surgery ,3. Good health ,Surgery ,Artery ligation ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,Fissure in Ano ,business ,Abdominal surgery - Abstract
International audience
- Published
- 2017
25. Outcomes of Doppler-guided hemorrhoid artery ligation: analysis of 90 consecutive patients
- Author
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M. Spyridakis, D. Symeonidis, Grigorios Christodoulidis, Konstantinos Tepetes, Efstathia Polychronopoulou, D. Dimas, and Alexandros Diamantis
- Subjects
Adult ,Male ,medicine.medical_specialty ,Time Factors ,Anesthesia, Spinal ,Hemorrhoids ,Hemorrhoidal disease ,Young Adult ,Recurrence ,Humans ,Medicine ,Surgical treatment ,Ligation ,Ultrasonography, Interventional ,Aged ,Hematoma ,Pain, Postoperative ,business.industry ,Gastroenterology ,Spinal anesthesia ,Ultrasonography, Doppler ,Long term results ,Middle Aged ,medicine.disease ,Colorectal surgery ,Surgery ,Artery ligation ,Female ,Fissure in Ano ,business ,Fecal Incontinence ,Autonomic Nerve Block ,Follow-Up Studies ,Abdominal surgery - Abstract
Doppler-guided hemorrhoid artery ligation is a minimal-invasive surgical treatment option for hemorrhoidal disease. The aim of our study was to evaluate the early and long-term results of the procedure 1 year after the operation.In a period of 4 years, 90 patients were included in this study. The Doppler-guided hemorrhoid artery ligation was performed under either spinal anesthesia or local perianal block. We recorded the length of postoperative inpatient care, on-demand analgesics administered apart from the standard analgesic protocol, short- and long-term complications, and, finally, recurrences.The mean age of patients was 46 ± 12.6 years. The operation was performed under spinal anesthesia in 82 patients and under local perianal block in 8 patients. The mean operative time was 26 ± 4.1 min. On-demand analgesics administration was reported in sixteen patients (17.7%) the first postoperative day and in four patients (4.4%) the second postoperative day. A total of 58 patients (64.4%) were discharged from the hospital the day of the operation, 29 (32.2%) patients stayed overnight, and in three (3.3%) patients, a hospitalization period of 2 days was needed. Four patients (4.4%), two with grade III and two with grade IV hemorrhoids, developed early postoperative complications. Late complications were observed in three patients (3.3%). Recurrences, manifested either as bleeding or as prolapsing piles, were observed in six patients (6.6%), two patients with initial grade III and four with grade IV hemorrhoids.Doppler-guided hemorrhoid artery ligation seems to be a safe and effective treatment option for all grades of hemorrhoidal disease. Further prospective randomized comparative studies are needed in order to fully evaluate the true role of DG-HAL in the surgical armamentarium.
- Published
- 2011
26. Treatment of chronic anal fissure with sacral neuromodulation: a pilot study.
- Author
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Muñoz-Duyos, A., Lagares-Tena, L., and Delgado-Rivilla, S.
- Subjects
- *
FISSURE in ano , *QUALITY of life , *BOTULINUM toxin , *THERAPEUTICS , *PAIN management , *NEURAL stimulation - Published
- 2017
- Full Text
- View/download PDF
27. A review of chronic anal fissure management
- Author
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Jonathan N. Lund and E. E. Collins
- Subjects
medicine.medical_specialty ,Botulinum Toxins ,medicine.drug_class ,Administration, Topical ,medicine.medical_treatment ,Chronic anal fissure ,Calcium channel blocker ,Postoperative Complications ,medicine ,Humans ,Nitric Oxide Donors ,Digestive System Surgical Procedures ,Anal fissure ,business.industry ,Gastroenterology ,Calcium Channel Blockers ,medicine.disease ,Dilatation ,Botulinum toxin ,Colorectal surgery ,Surgery ,Neuromuscular Agents ,Anal sphincter spasm ,Chronic Disease ,Fissure in Ano ,Lateral internal sphincterotomy ,business ,Algorithms ,Fecal Incontinence ,Abdominal surgery ,medicine.drug - Abstract
Anal fissure management has rapidly progressed in the last 15 years as our understanding of fissure pathophysiology has developed. All methods of treatment aim to reduce the anal sphincter spasm associated with chronic anal fissures. Surgical techniques have been used for over 100 years with success. Lateral internal sphincterotomy remains the surgical treatment of choice for many practitioners. Postoperative impairment of continence remains controversial. Recently, less invasive methods of treatment have been explored. Topical nitrates, calcium channel blockers and botulinum toxin are established treatments. These and other non-surgical treatments are described in this review. Various guidelines and treatment algorithms for anal fissure are also discussed.
- Published
- 2007
28. An evidence-based treatment algorithm for anal fissure
- Author
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W. R. Schouten, Georges Coremans, A. Herold, M. Spyrou, M. Pescatori, A A Sebastian, Per-Olof Nyström, I. Karaitianos, Jonathan N. Lund, and Surgery
- Subjects
Anal fissure ,medicine.medical_specialty ,Evidence-based practice ,business.industry ,Gastroenterology ,Non surgical treatment ,Isosorbide Dinitrate ,medicine.disease ,Colorectal surgery ,Fissure in ano ,Secondary care ,Nitroglycerin ,medicine ,Humans ,Surgery ,Nitric Oxide Donors ,Fissure in Ano ,business ,Algorithm ,Algorithms - Abstract
Guidelines for the treatment of anal fissure have been published in the USA and UK but differ. Many centers follow guidelines based on local experience. In December 2005, we met with the aim of developing an evidence-based treatment algorithm for anal fissure, applicable to both primary and secondary care. This algorithm may rationalize the treatment of anal fissure in primary and secondary care settings.
- Published
- 2006
29. The effect of oral administration of L–arginine on anal resting pressure and anodermal blood flow in healthy volunteers
- Author
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Martijn P. Gosselink, C. Esser, T. Teerlink, M. P. Buise, W. R. Schouten, H. A. Prins, L. E. Mitales, and Surgery
- Subjects
Adult ,Male ,Arginine ,Manometry ,Administration, Oral ,Anal Canal ,Sensitivity and Specificity ,Drug Administration Schedule ,Statistics, Nonparametric ,Nitric oxide ,chemistry.chemical_compound ,Reference Values ,Oral administration ,In vivo ,Pressure ,Humans ,Medicine ,Prospective Studies ,Probability ,Anal fissure ,Dose-Response Relationship, Drug ,business.industry ,Gastroenterology ,Blood flow ,Middle Aged ,medicine.disease ,Dose–response relationship ,chemistry ,Regional Blood Flow ,Anesthesia ,Female ,Surgery ,Fissure in Ano ,business ,Abdominal surgery - Abstract
Topical application of L-arginine, the precursor of nitric oxide, reduces anal resting pressure without significant side effects and may therefore be of benefit in the treatment of anal fissure. This in vivo study investigated the effect of orally administered L-arginine on anal resting pressure and anodermal blood flow in healthy volunteers.Eight healthy volunteers took 3 sachets of Arginaid (Novartis Consumer Health, Breda, The Netherlands) containing 15 g L-arginine on a daily basis, for 7 days. At the start of the experiment (day 0) and on days 3 and 7, plasma levels of L-arginine, anal resting pressures and anodermal blood flow were determined.Arginine plasma levels increased from 107.0+/-8.6 micromol/l (day 0) to 283.7+/-44.0 micromol/l on day 3 (p0.01) and remained elevated at day 7 (157.3+/-19.6 micromol/l, p0.05). Anodermal blood flow and anal resting pressures were similar on days 0, 3 and 7.Oral administration of 15 g arginine in healthy volunteers on a daily basis increased arginine plasma levels but had no influence on anodermal blood flow and anal resting pressure.
- Published
- 2005
30. Removal of hypertrophied anal papillae and fibrous anal polyps increases patient satisfaction after anal fissure surgery
- Author
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P. J. Gupta and S. Kalaskar
- Subjects
Adult ,Male ,medicine.medical_specialty ,Visual analogue scale ,medicine.medical_treatment ,Anal Canal ,Postoperative Complications ,Patient satisfaction ,Humans ,Medicine ,Prospective Studies ,Anal sphincterotomy ,Anus Diseases ,Anal fissure ,business.industry ,Gastroenterology ,Anal Polyp ,Intestinal Polyps ,Hypertrophy ,medicine.disease ,Colorectal surgery ,Surgery ,Major duodenal papilla ,Patient Satisfaction ,Chronic Disease ,Female ,Fissure in Ano ,business ,Abdominal surgery - Abstract
Hypertrophied anal papillae and fibrous anal polyps are frequently found in association with chronic fissure in ano. Usually, no specific attention is given to them and they are considered normal findings. The present prospective study was aimed at determining whether removal of hypertrophied anal papillae and fibrous anal polyps while dealing with chronic fissure in ano confers long-term benefit to patients. Between July 1999 and December 2000, 140 patients undergoing anal sphincterotomy were randomized into two groups to have their fibrous polyps and hypertrophied anal papillae either removed by radiofrequency surgery or left intact. After two years, they underwent a detailed interview by an independent, masked investigator. Overall 84% of patients who had polyp and papilla removal rated the outcome of their surgery as excellent or good in comparison to 58% of controls. The mean satisfaction grading was 9.2 on a visual analogue scale in the treatment group compared to 8.1 in controls (p=0.004). Removal of hypertrophied anal papillae and fibrous anal polyps should be an essential part of treatment of chronic fissure in ano. Persistence of these structures leaves behind a sense of incomplete treatment, reducing the overall satisfaction on the part of the patient. Radiofrequency procedure is useful in eradication of these concomitant pathologies.
- Published
- 2003
31. Quality of patient information on the internet for the treatment of anal fistula and anal fissure
- Author
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F, Scott, A, Sehgal, A, Seghal, H M, Joshi, T M, Yeung, and M P, Gosselink
- Subjects
Anal fistula ,Anal fissure ,Internet ,Consumer Health Information ,business.industry ,media_common.quotation_subject ,Gastroenterology ,medicine.disease ,Clinical trial ,Cohen's kappa ,Patient information ,Health care ,medicine ,Humans ,Rectal Fistula ,Surgery ,The Internet ,Quality (business) ,Medical emergency ,Fissure in Ano ,business ,media_common - Abstract
Patient use of the internet to get answers to medical questions is increasing, and many patients discuss the results of their findings with their health care providers [1, 2]. This is helpful considering the amount of information relayed by doctors that is taken in by patients is estimated to be between 40 and 80 % [3]. However, there is no monitoring or regulation of the information available online, and patients may find it challenging to discern good-quality information from poor-quality information. The combination of these factors could lead to patients being misinformed. Therefore, this study aims to assess the quality of the patient information available on the Internet about anal fissures and fistulas, and the treatment options for both. The three most popular search engines, Google (Mountain View, CA, USA), Yahoo (Sunnyvale, CA, USA), and Wikipedia (Wikipedia Web search engines), were used to identify websites that contained patient information about either anal fissures or anal fistulas. General search engines were used instead of medical search tools (e.g., PubMed) because it better reflects the way patients use the Internet to research conditions [4]. The search terms used were simply ‘‘anal fissure’’ and ‘‘anal fistula’’ to accurately simulate typical patient searches. Searches for both ‘‘anal fissure’’ and ‘‘anal fistula’’ were preformed in February 2014. Only the first 50 websites listed by each search engine were analyzed because the majority of Internet users do not look at websites beyond the first 50 results [5]. The inclusion criteria were websites that were free, did not require a password, were written in English, and provided patient information about either anal fissures or anal fistulas. Exclusion criteria included duplicate search results, advertisements, links, resources aimed at clinicians, clinical trials or guidelines, and discussion forums. Websites that met the inclusion criteria were assessed to determine the date of their last update (if given) and the affiliation of the group running the site. The content of each site was analyzed with focus on symptoms, investigations, treatment options and details, risks of each treatment option, and prognosis of either anal fissures or anal fistulas. The DISCERN instrument (www.discern.org.uk) was used to evaluate the quality and reliability of the information available [6]. The search results for ‘‘anal fissure’’ and ‘‘anal fistula’’ were both assessed independently by two of the authors. The kappa coefficient for this was 0.847. Any websites with discrepancies between the scores awarded by each author were re-evaluated by both authors together until a consensus on the score was reached. The search term ‘‘anal fistula’’ yielded 793,000 and 647,000 results in Google and Yahoo, while ‘‘anal fissure’’ yielded 915,000 and 1,040,000 results in the same. Of these results, the first 50 from each search engine were examined. In total, 200 websites were examined, of which 97 (48.5 %) met inclusion criteria: 45 from anal fistulas and 52 from anal fissures websites, respectively. Among the websites excluded, there were 57 duplicates, 26 clinician resources, 9 forums, 2 adverts, 2 videos, 2 websites that F. Scott A. Seghal Oxford University Medical School, Oxford, UK
- Published
- 2014
32. Long-term results of topical nitroglycerin in the treatment of chronic anal fissures are disappointing
- Author
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A. Graziano, S. Lencinas, Ubaldo Gualdrini, L. Svidler López, G. Masciangioli, and O. Bisisio
- Subjects
Adult ,Male ,medicine.medical_specialty ,Administration, Topical ,Placebo ,Nitroglycerin ,Recurrence ,medicine ,Humans ,Prospective Studies ,Prospective cohort study ,Aged ,Wound Healing ,Anal fissure ,business.industry ,Gastroenterology ,Long term results ,Middle Aged ,medicine.disease ,Colorectal surgery ,Surgery ,Clinical trial ,Treatment Outcome ,Anesthesia ,Acute Disease ,Chronic Disease ,Female ,Fissure in Ano ,business ,Follow-Up Studies ,Abdominal surgery ,medicine.drug - Abstract
Several treatments for anal fissure offer different responses and risks for complications. Reversible chemical sphincterotomy with topical nitroglycerin is an alternative to surgical sphincterotomy. The aim of this observational prospective study was to compare the effectiveness of topical nitroglycerin with the conventional medical treatment. Forty-three patients with anal fissure were treated: 22 (16 chronic and 6 acute) received 0.25% nitroglycerin topically, and 21 (16 chronic and 5 acute) received conventional treatment. Nitroglycerin or placebo was administered in two daily applications for two weeks. Median follow-up was 39 weeks. Healing rate with NTG was 75% for chronic and 83% for acute fissures, but recurrence rate for chronic fissures at 9 months was 67%. Healing rate with placebo for chronic fissures was only anecdotical (1 out of 16 patients). Headache as side effects occurred in 17 cases (77%). In conclusion, both treatments were effective for acute fissures, whereas for chronic ones NTG had a high healing rate but also a high recurrence rate.
- Published
- 2001
33. Percutaneous posterior tibial nerve stimulation in the treatment of refractory anal fissure.
- Author
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Moya, P., Arroyo, A., Mar Aguilar, M., Galindo, I., Giner, L., Bellón, M., Candela, F., and Calpena, R.
- Subjects
- *
FISSURE in ano , *THERAPEUTICS ,TIBIAL nerve injuries - Abstract
A letter to the editor is presented in response to the article about the stimulation of the percutaneous posterior tibial nerve and refractory anal fissure treatment.
- Published
- 2016
- Full Text
- View/download PDF
34. Nicorandil-induced severe perianal ulceration
- Author
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M. Atuf, R. K. S. Phillips, W. Al-Kubati, and R. P. Baker
- Subjects
Male ,ANAL ULCERATION ,medicine.medical_specialty ,Time Factors ,Vasodilator Agents ,Severity of Illness Index ,Angina Pectoris ,Angina ,medicine ,Humans ,Nicorandil ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Gastroenterology ,Potassium channel activator ,Middle Aged ,Prognosis ,medicine.disease ,Colorectal surgery ,Surgery ,Anesthesia ,cardiovascular system ,Female ,Fissure in Ano ,business ,Follow-Up Studies ,Abdominal surgery ,medicine.drug - Abstract
Nicorandil is a potassium channel activator used in the prevention and long-term treatment of angina pectoris. It is widely prescribed and its use is supported by data from powerful randomised controlled trials. The colorectal community is becoming increasingly aware of a subgroup of patients with anal ulceration and other gastrointestinal manifestations of nicorandil use.This study is a retrospective review of patients identified as having nicorandil-induced perianal ulceration. We report our experience of 11 patients.All eleven patients experienced severe debilitating ulceration of the perianal area and perineum. Multiple therapies were tried unsuccessfully before the association with nicorandil was recognised. Upon recognition of the association of nicorandil with these ulcers, the therapy was stopped resulting in resolution of the perianal symptoms.Nicorandil is a rare cause of severe perianal ulceration. This association should be recognised as these ulcers are resistant to other forms of treatment but heal well on ceasing nicorandil use.
- Published
- 2007
35. Ano-coccygeal support in the treatment of idiopathic chronic posterior anal fissure: a prospective non-randomised controlled pilot trial
- Author
-
Tikfu Gee, Yunus Gul Alif Gul, Raja B. Hisham, and Mohd Faisal Jabar
- Subjects
Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Young Adult ,medicine ,Humans ,Prospective Studies ,Young adult ,Toilet Facilities ,Prospective cohort study ,Aged ,Pain Measurement ,Anal fissure ,business.industry ,Urethral sphincter ,Gastroenterology ,Equipment Design ,Middle Aged ,medicine.disease ,Colorectal surgery ,Surgery ,Clinical trial ,Anesthesia ,Chronic Disease ,Female ,Fissure in Ano ,Lateral internal sphincterotomy ,business ,Abdominal surgery - Abstract
Idiopathic chronic anal fissure is believed to be a consequence of a traumatic acute anodermal tear followed by recurrent inflammation and poor healing due to relative tissue ischaemia secondary to internal sphincter spasm. This pilot trial compared the efficacy of a novel manufactured ano-coccygeal support attached to a standard toilet seat (Colorec) to the standard procedure of lateral internal sphincterotomy (LIS) for chronic anal fissure. Fifty-three patients with confirmed chronic anal fissures were enrolled and assigned, based on their preference, to the test group and the control group. Each patient was reviewed after therapy, and follow-up was scheduled at 4, 6 and 8 weeks and at 6 months. The fissure healing rate was 100 % in both groups. There were no statistically significant differences between the test group (n = 30, median age 42 years; range 20–71 years) and the control group (n = 22, median age 38 years; range 23–60 years) with regards to resolution of rectal bleeding at defaecation after 4 weeks (86.6 vs 72.7 %, p = 0.698), and by week 6, bleeding had resolved in 100 % of patients in both groups. There was no statistically significant difference between the test group and the control group with regards to pain scores at 4, 6 and 8 weeks (4.30 ± 0.79, 2.03 ± 0.80, 0.43 ± 0.50 vs 3.50 ± 0.74, 1.68 ± 0.56, 0.50 ± 0.51, p = 0.054) and to time until complete healing of fissures (5.60 ± 1.52 weeks vs 5.91 ± 1.57 weeks, p = 0.479). After continuous use of the ano-coccygeal support over 6 months, no patients in the test group had recurrent fissures. No complications were observed during the trial. Results of both methods were comparable and demonstrated that the ano-coccygeal support is at least as effective as LIS, without any short-term complications. Larger and randomised trials on the use of ano-coccygeal support for chronic anal fissures are awaited.
- Published
- 2011
36. Treatment of chronic anal fissure with topical nitroglycerin ointment 0.4%: a prospective clinical study
- Author
-
Alberto López-Delgado, Jair Santos, Fernando Candela, Pedro Moya, Jaime Ruiz-Tovar, Antonio Arroyo, Andres Frangi, Juan Pérez-Legaz, and Rafael Calpena
- Subjects
medicine.medical_specialty ,Side effect ,Administration, Topical ,Vasodilator Agents ,Placebo ,Internal anal sphincter ,Ointments ,Nitroglycerin ,medicine ,Humans ,Prospective Studies ,Anal fissure ,Dose-Response Relationship, Drug ,business.industry ,Gastroenterology ,medicine.disease ,Colorectal surgery ,Surgery ,Treatment Outcome ,Migraine ,Anesthesia ,Chronic Disease ,Fissure in Ano ,Headaches ,medicine.symptom ,business ,Abdominal surgery - Abstract
Of all of the available topical treatments for the treatment of anal fissure, nitroglycerin (NTG) ointment has been the most widely popularised. However, the different studies carried out with this ointment have been with customised compounded prescription medications prepared by pharmacists. There has been a disparity in the results arising from the inconsistency of the product, depending on the pharmacy and the methodology used in the research, namely different means of application, doses and concentrations [1]. Azarnoff et al. [2] have suggested that this heterogeneity of results existed because, to date, the studies that were conducted used formulas prepared in pharmacies (where it is not possible to ensure the exact concentration or the homogeneity of the whole tube), and thus, the dose was not exact. In one study of 24 pharmacies in the USA, it was observed that 46% of the pharmacies failed to comply with the exact formula (concentration and/or dose) prescribed, which created differences in the results reported regarding pain reduction due to NTG ointment and migraine associated with treatment. This problem has been solved with the recent appearance on the market of the first NTG ointment for commercial use Rectogesic (glyceryl trinitrate 0.4%), where both the concentration and the dose (dosifier) are precise. In our experience with Rectogesic in 120 patients, initial fissure healing was achieved in 87 patients (72.5%). In 6 cases, a relapse of the fissure occurred 4 months after treatment was completed. Therefore, the final healing rate was 67.5% (81 patients).There are few articles reported in the literature with this new formula that correct for the methodological defects mentioned above. However, we can assume that the long-term recurrence rate is high since anal pressures in repose revert to the pre-treatment values in the first 8 weeks after healing [3]. Nevertheless, we should expect the treatment to cause an initial improvement in the symptoms in most patients. On occasion, the treatment may produce incapacitating proctalgia with serious effects on quality of life. But, for the majority of patients, this treatment makes it possible to avoid irreversible resection of the internal anal sphincter and the postoperative consequences. Since the introduction of topical nitrates, the number of surgical interventions performed for anal fissure has fallen by 72% in England and 61% in Scotland [4]. As regards side effects, the risk of migraine (20–70%) is four times greater than with the placebo, as observed in the medical literature [5]. Nevertheless, although headaches may be serious, they tend to be temporary or transitory (in the first 30 min) and only necessitate withdrawal from the treatment in approximately 10% of the patients. When headaches do occur, they can be treated with mild analgesics before applying the ointment. To reduce the incidence of this side effect, the product should be applied with the finger protected by a finger cot in order to limit the absorption to the anal area and to reduce the absorption of the product through the skin of the finger. In our sample of 120 patients, headaches occurred in 63 patients (52.5%), but most were self-limiting or were relieved by oral analgesics. We must take into account the fact that the intensity of the migraine is always less than the pain caused by the anal fissure; therefore, it is not common for patients to abandon the treatment as a consequence of this side effect. J. Perez-Legaz A. Arroyo (&) J. Ruiz-Tovar A. Lopez-Delgado A. Frangi P. Moya J. Santos F. Candela R. Calpena Alicante, Spain e-mail: arroyocir@hotmail.com
- Published
- 2010
37. Prospective clinical trial comparing sphincterotomy, nitroglycerin ointment and xylocaine/lactulose combination for the treatment of anal fissure
- Author
-
E. Fahantidis, Aris Ioannidis, A. Mekras, G. Basdanis, Antonios Michalopoulos, V. N. Papadopoulos, D. Panagiotou, and E. Karamanlis
- Subjects
Adult ,Male ,medicine.medical_specialty ,Administration, Topical ,Vasodilator Agents ,Administration, Oral ,Anal Canal ,Ointments ,Lactulose ,Nitroglycerin ,medicine ,Humans ,In patient ,Prospective Studies ,Aged ,Anal fissure ,business.industry ,Gastroenterology ,Lidocaine ,Middle Aged ,medicine.disease ,Combined Modality Therapy ,eye diseases ,Colorectal surgery ,Surgery ,Clinical trial ,Anesthesia ,Drug Therapy, Combination ,Female ,Fissure in Ano ,business ,Gels ,Abdominal surgery ,medicine.drug ,Follow-Up Studies - Abstract
The aim of this study is to compare the ability of three treatments in patients with anal fissure, sphincterotomy, nitroglycerin ointment and combination of gel xylocaine and lactulose.Ninety adults divided in three groups of 30 patients each group, received one of the three treatments in a 3-year interval (2007-2009) and the follow-up was for 2 months. Group A received nitroglycerin ointment, Group B underwent sphincterotomy and Group C received gel xylocaine and lactulose.Concerning pain, after treatment 60% of patients in Group A did not complain of pain, 20% had transient pain, another 10% moderate pain and the remaining 10% had severe pain. In Group B, 95% of the patients had no pain and only 5% had mild, transient pain. In Group C 60% of the patients had moderate pain and the other 40% suffered from severe pain. Concerning fissure healing, in 60% of the patients of Group A, the fissure was healed. In Group B fissure healed in 93.3% and in Group C only in 16.6% of the patients.The "gold standard" for anal fissure treatment is the lateral internal sphincterotomy and that each one of the three methods has its advantages and disadvantages.
- Published
- 2010
38. Optimal treatment duration of glyceryl trinitrate for chronic anal fissure: results of a prospective randomized multicenter trial
- Author
-
F. Arcanà, Donato F. Altomare, Vincenzo J. Greco, Antonio Amato, Luigi Basso, P. De Nardi, I. De Stefano, A. Pulvirenti D’Urso, Leoluca Vasapollo, G. Gagliardi, F. La Torre, A. Bove, Domenico Aiello, A. Pascariello, and Danilo Cafaro
- Subjects
Adult ,Male ,medicine.medical_specialty ,Anal pain ,Time Factors ,Administration, Topical ,Chronic anal fissure ,anal fissure ,nitroglycerin ,anal pain ,nitric oxide ,Risk Assessment ,Severity of Illness Index ,Drug Administration Schedule ,law.invention ,Nitroglycerin ,Randomized controlled trial ,law ,Reference Values ,Multicenter trial ,Severity of illness ,medicine ,Humans ,Prospective Studies ,Prospective cohort study ,Pain Measurement ,Anal fissure ,Analysis of Variance ,Wound Healing ,Dose-Response Relationship, Drug ,business.industry ,Gastroenterology ,Nitric oxide ,Middle Aged ,medicine.disease ,Colorectal surgery ,Surgery ,Treatment Outcome ,Anesthesia ,Chronic Disease ,cardiovascular system ,Female ,Original Article ,Fissure in Ano ,business ,circulatory and respiratory physiology ,Abdominal surgery ,Follow-Up Studies - Abstract
Background Chronic anal fissure (CAF) is a painful condition that is unlikely to resolve with conventional conservative management. Previous studies have reported that topical treatment of CAF with glyceryl trinitrate (GTN) reduces pain and promotes healing, but optimal treatment duration is unknown. Methods To assess the effect of different treatment durations on CAF, we designed a prospective randomized trial comparing 40 versus 80 days with twice daily topical 0.4% GTN treatment (Rectogesic®, Prostrakan Group). Chronicity was defined by the presence of both morphological (fibrosis, skin tag, exposed sphincter, hypertrophied anal papilla) and time criteria (symptoms present for more than 2 months or pain of less duration but similar episodes in the past). A gravity score (1 = no visible sphincter; 2 = visible sphincter; 3 = visible sphincter and fibrosis) was used at baseline. Fissure healing, the primary endpoint of the study, maximum pain at defecation measured with VAS and maximum anal resting pressure were assessed at baseline and at 14, 28, 40 and 80 days. Data was gathered at the end of the assigned treatment. Results Of 188 patients with chronic fissure, 96 were randomized to the 40-day group and 92 to the 80-day group. Patients were well matched for sex, age, VAS and fissure score. There were 34 (19%) patients who did not complete treatment, 18 (10%) because of side effects. Of 154 patients who completed treatment, 90 (58%) had their fissures healed and 105 (68%) were pain free. There was no difference in healing or symptoms between the 40- and the 80-day group. There was no predictor of fissure healing. A low fissure gravity score correlated with increased resolution of pain (P
- Published
- 2010
39. Internal sphincterotomy using a self-illuminating forked scalpel
- Author
-
G. Piasentin
- Subjects
medicine.medical_specialty ,Anal fissure ,business.industry ,Internal Anal Sphincterotomy ,General surgery ,medicine.medical_treatment ,education ,Gastroenterology ,medicine.disease ,Colorectal surgery ,Fissure in ano ,Internal anal sphincter ,Surgery ,Surgical therapy ,Medicine ,Fecal incontinence ,medicine.symptom ,business ,Lateral internal sphincterotomy ,health care economics and organizations - Abstract
The aim of lateral internal sphincterotomy when treating fissure in ano is to divide the distal one-third of the internal anal sphincter (IAS). This section is sufficient to allow the anal fissure to heal, and to guarantee good continence. The incidence of fecal incontinence after internal anal sphincterotomy, particularly in women, suggests that particular attention is needed in the surgical therapy of fissures in women to avoid an excessive section of the IAS.
- Published
- 2000
40. Fissurectomy combined with anoplasty and injection of botulinum toxin in treatment of anterior chronic anal fissure with hypertonia of internal anal sphincter: a pilot study
- Author
-
A. Tornambè, G. Asaro, Fausto Famà, Rosalia Patti, G Di Vita, Patti, R, Famà, F, Tornambè, A, Asaro, G, and Di Vita, GG
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,Pilot Projects ,Injections, Intramuscular ,Surgical Flaps ,Internal anal sphincter ,Cohort Studies ,Young Adult ,Muscle Hypertonia ,medicine ,Humans ,chronic anal fissure ,Botulinum Toxins, Type A ,Defecation ,business.industry ,Anorectal manometry ,Gastroenterology ,Recovery of Function ,Middle Aged ,Botulinum toxin ,Colorectal surgery ,Surgery ,Clinical trial ,Treatment Outcome ,Neuromuscular Agents ,Anesthesia ,Anterior chronic anal fissure, Fissurectomy, Advancement flap, Botulinum toxin ,Hypertonia ,Female ,Fissure in Ano ,medicine.symptom ,business ,medicine.drug ,Abdominal surgery - Abstract
BACKGROUND: In patients affected by anterior chronic anal fissure (CAAF) with hypertonia of the internal anal sphincter (IAS), the role of IAS hypertonia remains unclear. The aim of this study was to evaluate the efficacy of fissurectomy combined with advancement flap and IAS injection of botulinum toxin in healing the CAAF with hypertonia of IAS resistant to medical therapy. METHODS: Ten consecutive patients were enrolled. Anorectal manometry was performed preoperatively and at 6 months. CAAF with hypertonia was defined as those associated with maximum resting pressure (MRP) values higher than 85 mmHg. All patients underwent fissurectomy and anoplasty with advancement skin flap combined with the intrasphincter injection of 30 UI of botulinum toxin. Complete healing, MRP changes, relief of symptoms and immediate and long-term complications were recorded. RESULTS: Complete healing was observed in all patients within 30 days of the operation. The intensity and duration of pain post-defecation was reduced significantly starting from the first defecation. In all subjects, the preoperative MRP values were significantly reduced at 6 months. One month after surgery, three patients reported anal incontinence, two of them had complained preoperatively. The only postoperative complications were minor. CONCLUSIONS: Fissurectomy combined with advancement flap and intrasphincter injection of botulinum toxin results in complete healing, significant MRP reduction and full relief of symptom in all patients, thus it represents a valid procedure in preventing the occurrence of anal incontinence.
- Published
- 2009
41. A pilot comparative study of fissurectomy/diltiazem and fissurectomy/botulinum toxin in the treatment of chronic anal fissure
- Author
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J. D. Arthur, C. J. Walsh, Christopher Soll, T. Y. El-Sayed, C. A. Makin, Dieter Hahnloser, and University of Zurich
- Subjects
Adult ,Male ,medicine.medical_specialty ,Perianal sepsis ,Chronic anal fissure ,Pilot Projects ,142-005 142-005 ,Statistics, Nonparametric ,Diltiazem ,Healing rate ,medicine ,Humans ,2715 Gastroenterology ,Botulinum Toxins, Type A ,Retrospective Studies ,Chi-Square Distribution ,business.industry ,Gastroenterology ,Middle Aged ,Calcium Channel Blockers ,Botulinum toxin ,Colorectal surgery ,Surgery ,2746 Surgery ,medicine.anatomical_structure ,Treatment Outcome ,Neuromuscular Agents ,Chronic Disease ,Sphincter ,Female ,Fissure in Ano ,business ,medicine.drug ,Abdominal surgery - Abstract
Background: Treatment of chronic anal fissure (CAF) by fissurectomy with botulinum toxin A (BTA) injection results in a healing rate of greater than 90%. BTA injection, however, can cause incontinence and perianal sepsis. The decrease in sphincter pressure following topical treatment with 2% diltiazem cream (DTC) is comparable to that following BTA injection but with potentially fewer complications and at less cost. We report the shortterm results of a pilot study comparing fissurectomy with BTA and fissurectomy followed by DTC for the treatment of CAF. Methods: The recorded outcomes of CAF following treatment with the two methods were analysed retrospectively. Patients underwent either fissurectomy followed by injection of 40 U BTA into the internal sphincter (group A) or fissurectomy followed by the perianal application of DTC twice daily for 8 weeks (group B). Symptom resolution and treatment side effects at the initial follow-up were compared. Results: Demographics, fissure characteristics and the number of multiparous women between the two groups were comparable. At a median follow-up of 12 weeks (range 8-20 weeks), the two groups had similar rates of complete symptom resolution (group A, 25/28, 89.3%; group B, 19/23, 82.6%; p=0.7739), with minor side effects. Conclusions: In this small pilot study fissurectomy combined with chemical sphincterotomy resulted in high short-term fissure healing rates. The study also suggested that fissurectomy followed by 8 weeks of topical DTC may be as good as fissurectomy with BTA injection in the treatment of CAF. A prospective study, adequately powered to determine the significance of differences is needed
- Published
- 2008
42. Posterior perineal support as treatment for anal fissures--preliminary results with a new toilet seat device
- Author
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Chew Heng Hai, Gan Kok Thye, Kok-Yang Tan, and Francis Seow-Choen
- Subjects
Adult ,Male ,medicine.medical_specialty ,Constipation ,Young Adult ,Surveys and Questionnaires ,medicine ,Odds Ratio ,Humans ,Prospective Studies ,Toilet Facility ,Toilet Facilities ,Defecation ,Toilet ,Anal fissure ,Pelvic floor ,business.industry ,Gastroenterology ,Equipment Design ,Pelvic Floor ,Middle Aged ,medicine.disease ,Perineum ,Surgery ,medicine.anatomical_structure ,Treatment Outcome ,Patient Satisfaction ,Counter pressure ,Female ,Fissure in Ano ,medicine.symptom ,business ,Follow-Up Studies - Abstract
Anal fissures can cause morbidity in an otherwise healthy young patient. The process of evacuation results in stretching and descent of the anoderm and perineum especially posteriorly. Posterior perineal support may provide counter pressure at the posterior aspect of the pelvic floor, balancing the pressure exerted by the faeces on the anal wall, thus improving evacuation and reducing the trauma associated with it, and reducing symptoms of anal fissures. Symptoms of constipation may also be reduced secondarily. We report the preliminary results with a novel, simple and noninvasive method of treatment provided by a toilet seat device.A prospective study was performed in 32 patients. The study was designed mainly to investigate the patients' subjective perceptions of their symptoms related to anal fissures and constipation. Questionnaires were provided to patients before, during and after treatment.The study revealed statistically significant improvement in pain, bleeding, symptoms of constipation and abdominal discomfort after 3 months usage of the device. The odds of patients perceiving an improvement in symptoms were also significantly increased after 3 months of treatment compared to 2 weeks of treatment.This preliminary study revealed that a posterior perineal support device can bring about significant improvement in the symptoms of patients with anal fissures. There may also be secondary benefits of a reduction in the symptoms of constipation. Although not conclusive, these results should serve as a springboard for further research into this area.
- Published
- 2008
43. Endoscopic lesions in low-to average-risk patients with minimal bright red bleeding from midline anal fissures. How much should we go in?
- Author
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Rasoul Sotoudehmanesh, A. A. Asgari, Sanaz Ainechi, and Shadi Kolahdoozan
- Subjects
Adult ,Male ,medicine.medical_specialty ,BRIGHT RED RECTAL BLEEDING ,Colonoscopy ,Risk Assessment ,Severity of Illness Index ,Diagnosis, Differential ,Risk Factors ,medicine ,Humans ,Prospective Studies ,Sigmoidoscopy ,Gastrointestinal endoscopy ,Average risk ,Anal fissure ,medicine.diagnostic_test ,business.industry ,Gastroenterology ,medicine.disease ,Prognosis ,Colorectal surgery ,Surgery ,Female ,Fissure in Ano ,business ,Colorectal Neoplasms ,Gastrointestinal Hemorrhage ,Abdominal surgery ,Follow-Up Studies - Abstract
Anal fissure is a common condition in young patients, and the main symptoms include anal pain and bleeding. Our aim was to determine the need to perform lower gastrointestinal endoscopy on patients with midline anal fissure who present with minimal bright red rectal bleeding and who are at low risk for colorectal neoplasia.Patients with midline anal fissure who reported small amounts of red blood on toilet paper, toilet bowl or stool after defecation were evaluated. Patients with alarm signs (recently altered bowel habit, weight loss, anemia and family or personal history of colorectal neoplasms) were excluded. A total of 134 patients (80 female and 54 male, aged 35.8+/-11.4 years) were studied. Patients younger than 40 years underwent flexible sigmoidoscopy and colonoscopy was used for older ones.Fissures were posterior in 106 cases (79.1%) and anterior in 27 cases (20.1%); one patient (0.7%) had both anterior and posterior fissures. The lower gastrointestinal endoscopy was normal in 120 patients (89.6%), and 36 patients (26.9%) had associated internal hemorrhoids. Adenomatous polyps were found in 4 cases (3.0%), ulcerative colitis in 8 (6.0%) and Crohn's disease in one patient (0.7%). There was no case of adenocarcinoma.Clinical evaluation plus rectoscopy might be the appropriate evaluation in this selected group of patients, if our results are confirmed by further studies.
- Published
- 2007
44. Methylene blue injection reduces pain after lateral anal sphincterotomy
- Author
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K Y, Tan and F, Seow-Choen
- Subjects
Adult ,Male ,Methylene Blue ,Pain, Postoperative ,Treatment Outcome ,Humans ,Female ,Fissure in Ano ,Prospective Studies ,Middle Aged ,Aged ,Injections ,Pain Measurement - Published
- 2007
45. Meta-analysis of botulinum toxin injection for chronic anal fissure: healing rates controversies.
- Author
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Vergara-Fernández, O., Salgado-Nesme, N., Navarro-Navarro, A., and Rangel-Ríos, H.
- Subjects
- *
BOTULINUM toxin , *FISSURE in ano , *RANDOMIZED controlled trials , *THERAPEUTICS - Abstract
A letter to the editor is presented in response to the article "Botulinum toxin injection versus lateral internal sphincterotomy for chronic anal fissure: a meta-analysis of randomized control trials" by H. L. Chen and colleagues that was published in the previous issue.
- Published
- 2017
- Full Text
- View/download PDF
46. Calibrated lateral internal sphincterotomy for chronic anal fissure
- Author
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Piccinelli D, S. Bonomo, P. Lolli, Rosa G, F. Mazzola, Chiara Zugni, and A. Ballarin
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,Manometry ,medicine.medical_treatment ,Chronic anal fissure ,Anal Canal ,Anal continence ,medicine ,Humans ,Digestive System Surgical Procedures ,Aged ,Retrospective Studies ,Aged, 80 and over ,Anal fissure ,business.industry ,Gastroenterology ,Follow up studies ,Middle Aged ,medicine.disease ,Colorectal surgery ,Surgery ,chronic anal fissure calibrated lateral internal sphincterotomy manometry ,medicine.anatomical_structure ,Treatment Outcome ,Chronic Disease ,Hypertonia ,Sphincter ,Female ,Fissure in Ano ,medicine.symptom ,business ,Lateral internal sphincterotomy ,Follow-Up Studies - Abstract
Lateral internal sphincterotomy is an effective procedure for the treatment of anal fissure, but may affected anal continence. We describe a procedure aimed at tailoring the division of the sphincter according to the degree of the hypertonia and to the sphincter length in order to offer an effective and safe treatment for chronic anal fissure.The internal sphincter was divided on the basis of anal manometry results. The average of maximum values of resting pressure determined by the stationary motility protocol was considered the reference parameter to measure hypertonia. Mild hypertone was considered to be 50-60 mmHg, moderate hypertone 60-80 mmHg, and severe hypertone80 mmHg. In case of mild hypertone, 20% of the internal sphincter was divided; in case of moderate hypertone; 40% and 60% for severe hypertone. Calibrated lateral internal sphincterotomy is the division of the internal sphincter based on these parameters. Over 5 years, 388 patients underwent this procedure (197 men, 191 women) with a median age of 43 years (range, 18-80).Postoperative complications consisted of abscess in 4 patients (1.0%), hemorrhage in 2 patients (0.5%), and pain in 6 patients (1.5%). Follow-up data are available for 261 patients (67.3%). Two months after surgery, 9 patients (3.4%) complained of persistent or recurring pain with or without fissure and 1 (0.4%) complained of gas incontinence. At postoperative manometry, 12 patients (4.6%) revealed persistence of anal resting pressure over 40 mmHg, 9 patients (3.4%) were still symptomatic and 97.6% were cured at a median follow-up of 8 months. An anal resting pressure lower than 30 mmHg was found in 10 patients (3.8%), only one of whom was incontinent.Calibrated sphincterotomy may represent an effective and safe procedure for the treatment of chronic anal fissure.
- Published
- 2005
47. Hydropneumatic anal dilation in conservative treatment of chronic anal fissure: clinical outcomes and randomized comparison with topical nitroglycerin
- Author
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M. Tosoni, F. Barberani, M. Giovannone, and S. Boschetto
- Subjects
Male ,medicine.medical_specialty ,Administration, Topical ,Vasodilator Agents ,Chronic anal fissure ,Catheterization ,law.invention ,Nitroglycerin ,Randomized controlled trial ,law ,Humans ,Medicine ,Surgical approach ,business.industry ,Gastroenterology ,Middle Aged ,Colorectal surgery ,Surgery ,Clinical trial ,Conservative treatment ,Treatment Outcome ,Anesthesia ,Chronic Disease ,Feasibility Studies ,Dilation (morphology) ,Female ,Fissure in Ano ,business ,Abdominal surgery - Abstract
The surgical approach in chronic anal fissures (CAF) may, occasionally result in anal incontinence. The aim of this investigation was to study feasibility, effectiveness, and safety of hydropneumatic anal dilation (HAD) in conservative treatment of CAF and to compare it with local nitroglycerin (GTN) treatment. Efficacy of HAD was evaluated in 109 patients (65 male, 44 female; mean age, 53.3 years), following anal dilation using Microvasive Rigiflex instrument (Otw 40 mm). Thereafter, 36 patients were randomly divided into two groups to undergo treatment with 0.25% GTN or HAD. Recovery rate with HAD was 79.8% after 10 days and 94.5% after 30 days. An immediate (within 24 hours) drop was observed in the level of pain; no significant complications or recurrence were reported within 2 years. Healing rate was 94.5% following HAD vs. 38.9% after GTN. HAD should be considered a new safe option in CAF treatment.
- Published
- 2004
48. Long-term assessment of fecal incontinence after lateral internal sphincterotomy
- Author
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M. V. Mauri, M. E. Bun, R. Bosio, N. A. Mezzadri, C. E. Peczan, and Nicolas A. Rotholtz
- Subjects
Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Urology ,Chronic anal fissure ,Anal Canal ,Postoperative Complications ,medicine ,Fecal incontinence ,Humans ,Aged ,Retrospective Studies ,business.industry ,Vaginal delivery ,Medical record ,Incidence ,Significant difference ,Gastroenterology ,Middle Aged ,Colorectal surgery ,Surgery ,Chronic Disease ,Female ,Fissure in Ano ,medicine.symptom ,business ,Lateral internal sphincterotomy ,Fecal Incontinence ,Abdominal surgery ,Follow-Up Studies - Abstract
Lateral internal sphincterotomy (LIS) can cause fecal incontinence. The aim of this study was to evaluate this sequelae after long–term follow–up of patients treated by LIS and to identify possible associated factors. Data were retrospectively collected for patients with chronic anal fissure who had LIS between 1994 and 1997. Continence was assessed according to the incontinence score (IS) obtained by medical record review and telephone questionnaire. Statistical analysis was performed using by Student's t test for qualitative variables and chi–square test for qualitative variables. All 68 patients evaluated had healed after fissure surgery. None of these patients had preoperative fecal incontinence neither recurrence at the time of follow–up. At a mean follow–up of 66.6 months (range, 30–84 months), 7 patients (10.2%) were incontinent (mean IS=8.2; range, 5–16) and none had recovered continence at the time of follow–up. There was no significant difference between patients with and without fecal incontinence relative to gender age, hemorrhoidectomy combined with LIS, or vaginal delivery. Incontinence due to LIS does not recover after long-term follow-up and appears to be an independent cause of fecal incontinence.
- Published
- 2004
49. A study of suppurative pathologies associated with chronic anal fissures
- Author
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P. J. Gupta
- Subjects
Adult ,Male ,medicine.medical_specialty ,Fistula ,Electrosurgery ,medicine ,Humans ,Rectal Fistula ,Abscess ,Retrospective Studies ,Anal fissure ,Suppuration ,business.industry ,Gastroenterology ,medicine.disease ,Primary lesion ,Colorectal surgery ,Surgery ,Treatment Outcome ,Chronic Disease ,Female ,Fissure in Ano ,business ,Abdominal surgery ,Follow-Up Studies - Abstract
Suppurative pathologies associated with chronic anal fissures are common but not well documented. Fissure abscess, post-fissure fistula, and post-fissure antibioma are but a few of them. These pathologies increase the complications and morbidity of the primary lesion and need a comprehensive approach.From the hospital case record of 532 patients treated for chronic anal fissures, 88 patients (16.5%) were found to have one of these pathologies. This retrospective study describes such pathologies in terms of demographics, clinical presentation, pathological features, operative technique and outcome.Of the 88 patients who presented with pain and discharge per anus, 90% could resume their duties within a week of the surgical procedure. Wound healing took between 2 weeks and 2 months. At the last follow- up at 18 months, three patients had a recurrence (3.4%).Suppuration in chronic anal fissure seems to be more frequent than described. While dealing with the anal fissure, it is desirable to look for and attend to these associated pathologies, especially to avoid complications and morbidity of the primary disease.
- Published
- 2003
50. Different anal pressure profiles in patients with anal fissure
- Author
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F. Pucciani, P. Perrotti, A. Bove, C. Antropoli, A. Balzano, and Giovanni Lombardi
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,Manometry ,Rectum ,Anal Canal ,medicine ,Pressure ,Humans ,Aged ,Anal fissure ,business.industry ,Anorectal manometry ,Gastroenterology ,Anal canal ,Middle Aged ,medicine.disease ,Colorectal surgery ,Surgery ,medicine.anatomical_structure ,Chronic Disease ,Reflex ,Anal verge ,Female ,Fissure in Ano ,business ,Abdominal surgery - Abstract
A consistent debate exists about the association between anal fissure and hypertonic anal canal. The aim of this study was to determine if the manometric findings in patients with chronic anal fissures varied according to the topography of the fissure. Seventy-three outpatients (52 men, 71%) with chronic anal fissures and nine healthy volunteers (5 men, 55%) were examined. Patients were classified according to the topography of the anal fissures: posterior midline (group A), anterior midline (group B), and lateral position (group C). We use computerized anorectal manometry to evaluate anal resting pressure, maximal voluntary contraction, recto-anal inhibitory reflex, rectal sensations and rectum compliance. In Group A, the mean pressure was higher than that of controls (p
- Published
- 2002
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