Search

Aim: Chronic anal fissure (CAF) is an extremely frequent finding in clinical practice. Several topical agents have been proposed for its treatment with the common goal of increasing anodermal blood flow to promote healing. The aim of this study was to compare the efficacy and safety of a Propionibacterium extract gel (PeG) and 0.4% glyceryl trinitrate ointment (GTN) in patients with CAF. Method: Patients were randomly allocated to a PeG or GTN group and medication was administered every 12 h for 40 days. The primary outcome was the success rate, as measured by a decrease in the REALISE scoring system for anal fissure at 10, 20 and 40 days after initiating either treatment. The secondary outcomes recorded at the same time points were healing rate, visual analogue scales for itching and burning, rate of complications and adverse events, patient quality of life and satisfaction, and cost analysis. Results: A total of 120 patients were enrolled, and 96 patients (PeG, n = 53; GTN, n = 43) completed the primary outcomes. A significant decrease over time in the REALISE score was observed in both groups. Adverse events occurred more frequently in the GTN group than in the PeG group, peaking at visit 1 [37 (63.8%) vs. 2 (3.4%), respectively], with headache being the most prevalent. The between‐treatment cumulative average costs per patient were significantly higher for GTN than that for PeG at each follow‐up visit. There were no other significant differences between the two groups for any of the other outcomes. Conclusion: While there was no difference in healing rates between the two treatments, PeG was more cost‐effective and associated with fewer adverse events. [ABSTRACT FROM AUTHOR]

Aim: Cloacal deformity is a disabling condition that severely affects a patient's quality of life. Surgery to repair cloacal deformity remains the mainstay of treatment. The aim of this study is to assess the clinical and functional outcome of patients treated for traumatic cloacal deformity by three different techniques. Method: A retrospective multicentre study was carried out using data from women operated on for cloacal deformity between 2015 and 2019. Demographic characteristics, the presence of urinary and/or faecal incontinence and manometric findings were collected. The main outcome measures were represented by St Mark's and Rockwood faecal incontinence quality of life scores. Results: Thirty eight women with a median age of 34 years [interquartile range (IQR) 31–39 years] were enrolled. Perineoplasty was performed in 23 patients by direct suture of the rectovaginal septum, in five using the X‐flap and in 10 by the Singapore flap. Median resting and squeezing pressures increased significantly from 28.15 (IQR 23–32.7) cmH2O to 45 (IQR 31–60.7) cmH2O (p = 0.0001) and from 47 (IQR 41.2–54.7) cmH2O to 97.2 (IQR 80–118) cmH2O (p = 0.0001), respectively. Maximum tolerable volume improved from 120 (IQR 90–137.5) ml to 137.5 (IQR 120–150) ml (p = 0.002). The St Mark's score decreased from 18 (IQR 14–20) to 4.5 (IQR 2–8) after 20 months (p = 0001). Sexual activity was confirmed by 16 patients preoperatively and by 27 postoperatively. A diverting stoma was performed in three patients after X‐flap perineoplasty and in 14 treated by direct closure. No significant differences were found pre‐ and postoperatively between the three groups. Conclusion: Regardless of the technique used, surgical repair significantly improves both clinical and functional outcomes irrespective of the presence of a covering stoma. [ABSTRACT FROM AUTHOR]