Management Of Chronic Anal Fissure Research Articles

Comparing Outcomes of Lateral Internal Sphincterotomy and Laser sphincterolysis in the Management of Chronic Anal Fissure

Comparing Outcomes of Lateral Internal Sphincterotomy and Laser sphincterolysis in the Management of Chronic Anal Fissure

Initial Outcome of Lateral Internal Sphincterotomy with or without Fissurectomy in the Surgical Management of Chronic Anal Fissure

Chronic anal fissure is a common proctological condition characterized by severe pain and bleeding during defecation. Surgical intervention is often required for chronic cases unresponsive to conservative treatment. This study aims to compare the outcome of lateral internal sphincterotomy (LIS) with and without fissurectomy. In this single-centered study, 50 purposively selected patients with chronic anal fissures were divided into two groups: Group A underwent LIS with fissurectomy, while Group B underwent only LIS. The primary outcomes measured were postoperative anal pain relief and fissure healing rates, while secondary outcomes included hospital stay duration and the occurrence of complications such as anal discharge, pruritus, bleeding spot, urine & stool incontinence. Group A showed a significant reduction in postoperative pain within 3 days (60% of patients) compared to Group B, which showed relief within 6-8 days (32% of patients). Fissure healing times were faster and hospital stay duration were shorter in Group A, with a mean duration of 5.12±1.616 days versus 8.32±3.18 days in Group B. The incidence of postoperative complications was lower in Group A, with anal discharge occurring in 16% of patients compared to 44% in Group B. These above differences were statistically significant. The study demonstrates that LIS with fissurectomy may offer better outcomes in the treatment of chronic anal fissures than LIS alone, including faster pain relief, improved healing rates and fewer postoperative complications. Given the limitations of a small sample size and single-center design, larger multi-center trials are recommended to confirm these findings and potentially adjust clinical practice guidelines.

Outcomes of non-surgical treatment of chronic anal fissure: A comparative study

Background and objective: Chronic anal fissure is a common health problem related to high morbidity. The chemical option for treating chronic anal fissures is highly preferred. Methods: A clinical prospective comparative study was carried out in the General Surgery Outpatient Department in Rizgary Teaching Hospital, Erbil, KRG, during the period from January 2019 to December 2021,on a sample of 100 patients randomly recruited patients with chronic anal fissures divided into two groups with 50 participants each: the DTZ group, who received 2% diltiazem ointment, and the GTN group, who used 0.2% glyceryl trinitrate ointment twice daily for 6 consecutive weeks. The aim of the study is to compare the efficacy and effects of topical Diltiazem (DTZ) and topical glyceryl trinitrate (GTN) in the management of chronic anal fissures. Results: There was a highly significant association between fissure healing at the 4th week and patients treated with DTZ (P <0.001). A highly significant association was observed at the 6th week between fissure healing and DTZ treatment (P <0.001), while there was later a highly significant association between fissure healing at the 8th week and patients treated with GTN (P <0.001). A significant association was observed between treatment adverse effects and patients treated with GTN (P = 0.05). DTZ was found to be more effective for symptomatic relief than GTN. Conclusion: Both DTZ and GTN are effective in the treatment of chronic anal fissures, but treatment with DTZ is accompanied by faster healing and lower side effects.

Comparing closed versus open lateral internal sphincterotomy for management of chronic anal fissure: systematic review and meta-analysis of randomised control trials

Chronic anal fissure is one of the most common benign anorectal health conditions, causing significant morbidity, quality of life, and economic loss. Eight randomized controlled trials with a total population size of 1035 were eligible for analysis. Seven studies included both males and female, while one only included females. The majority of randomized controlled trials involved female dominance [54.9% (43.5–66.3)] and posterior midline location [86.1% (95% CI 81.5–90.8%)]. This meta-analysis of randomised control trials found that overall postoperative healing was 90.2%, recurrent anal fissure was 3.7%, and postoperative incontinence was 8.9% after LIS. Even though there was no statistically significant difference, closed lateral internal sphincterotomy (LIS) had higher rates of recurrent anal fissure (RR = 1.73 (95% CI 0.86–3.47, p = 0.90, I2 = 0%) and lower rates of postoperative incontinence rate (RR = 0.60 (95% CI 0.37–0.96, p = 0.76, I2-0) as compared with open LIS. We recommended that closed lateral internal sphincterotomy (LIS) is a safe and effective surgical treatment option for chronic anal fissures.

The Assessment of Marcaine Versus Meperidine for Spinal Anesthesia in Anorectal Surgery: A Randomized Clinical Trial.

Spinal anesthesia (SA) for the surgical management of chronic anal fissures is favored by surgeons as it provides an early return to daily activities; however, the agents applied for SA to achieve the best outcomes with minimized adverse effects are a matter of debate. This study aimed to assess the utility of Marcaine versus meperidine for SA induction of anoderm surgery. This randomized clinical trial (RCT) was conducted on 138 patients with chronic anal fissures who were candidates for surgical management in 2020. The patients were randomly assigned to two groups of SA using 2.5 mL of hyperbaric Marcaine 0.5% (n = 69) or 1 mg/kg of meperidine (n = 69). Pain severity (measured via Numerical Rating Scale (NRS)), anal sphincter tone manometry (measured at baseline and the end of the sphincterotomy), and drug-related adverse effects were compared between the groups. Both agents led to significant pain relief within 24 hours after SA (P < 0.05); nevertheless, pain severity was remarkably lower in meperidine-treated patients in different measurements performed during the first 24 hours after SA (P < 0.05). The sphincteric tone significantly decreased in both groups (P < 0.001), while the postoperative tone was significantly less in the Marcaine-treated patients (65.22 ± 3.02 versus 46.04 ± 1.97, P < 0.001). The two groups did not differ regarding the adverse effects (P > 0.05). Meperidine for SA in anal fissure surgical management was relatively superior to Marcaine, as postoperative pain control was remarkably better achieved with meperidine. However, anal sphincter tone reached a normal range in Marcaine-treated cases, and the average tone in those anesthetized with meperidine was slightly above the normal limits.

CLINICAL STUDY OF CHRONIC FISSURE-IN-ANO AND COMPARATIVE STUDY OF DIFFERENTMODALITIESOF ITS TREATMENT IN NMCH&amp;RC

Anal fissure is a most common painful condition whichcauses considerable morbidity and affects the patients quality of life to a greater extent. The majority of acute anal fissures heal spontaneously. However, some of the acute anal fissures do not resolve but become chronic. Thiswarrantsprompttreatmentof the condition with appropriatemethods.Selecting a better method of treating this condition that can achieve optimal clinical results and getting the least pain and inconvenience to the patient has always posed a challenge to the surgeons. This has led to the innovation of a number of surgical and pharmacological methods that relaxes the anal sphincter. Aimof The Study:To study the different clinical presentations and etiological factors of the fissure in ano&amp; different modalities of treatment of fissure in ano i.e., application of 2% Diltiazem ointment, Lords Anal Dilatation and Subcutaneous Lateral Internal Sphincterotomy. &amp;to evaluate the efficacy Subcutaneous Lateral Internal Sphincterotomyas a treatment modality in the management of chronic anal fissure in comparison with application of 2% Diltiazem ointment &amp; with Lords Anal Dilatation. Materials &amp; Methods: The material for the study was taken from the cases attending thesurgery OPD and admitted In-patients of all the units of the Department of General Surgery, Navodaya Medical College Hospital &amp; Research Centre,whowerediagnosed to haveChronicanal fissure. This study was a prospective study which included 90 patients presenting with chronic anal fissure over a period of 18 months from November 2019 to May 2021.Thesepatientswererandomly selectedandclassifiedintothree groups(A,B,C) eachconsistingof30 patients &amp; each group with one type of treatment modality, like group A for 2% diltiazem, B for lords anal dilatation &amp; C for LIS. Follow-up of the patients was done by history and per-rectalexamination to assess the efficacy of the treatment and the complications like pain,bleeding,sphincter spasm, dischargeperanum and incontinence. Results :This study showed the results in favour of Lateral Internal Sphincterotomywith a healing rate of 100% with faster pain-relief and minimal or no complications ifperformedbythehands of an experienced surgeon, whereas latency in the clearance of symptoms and lesions was seen with 2% Diltiazem and Lords Anal Dilatation with adverse effects as well. With the healingrate of 100% of Fissure-in-ano in LIS therapy group, 81% in Lords Anal Dilatation and 71% with topical 2% Diltiazem therapy, &amp; adverse effects or complications being maximum in 2% Diltiazem therapy group, 13 patients (46%) when compared to Lords Anal Dilatation (41% , 11 patients) and LIS group (32%, 09 patients), weconcludethatLateralinternalsphinterotomy(LIS) appearstobethebetterlineoftreatmentasthereis 100%healingrate, minimal complications and no recurrence.

CLINICAL STUDY OF CHRONIC FISSURE-IN-ANO AND COMPARATIVE STUDY OF DIFFERENTMODALITIESOF ITS TREATMENT IN NMCH&amp;RC

Anal fissure is a most common painful condition whichcauses considerable morbidity and affects the patients quality of life to a greater extent. The majority of acute anal fissures heal spontaneously. However, some of the acute anal fissures do not resolve but become chronic. Thiswarrantsprompttreatmentof the condition with appropriatemethods.Selecting a better method of treating this condition that can achieve optimal clinical results and getting the least pain and inconvenience to the patient has always posed a challenge to the surgeons. This has led to the innovation of a number of surgical and pharmacological methods that relaxes the anal sphincter. AimofThe Study:To study the different clinical presentations and etiological factors of the fissure in ano&amp; different modalities of treatment of fissure in ano i.e., application of 2% Diltiazem ointment, Lords Anal Dilatation and Subcutaneous Lateral Internal Sphincterotomy. &amp;to evaluate the efficacy Subcutaneous Lateral Internal Sphincterotomyas a treatment modality in the management of chronic anal fissure in comparison with application of 2% Diltiazem ointment &amp; with Lords Anal Dilatation. Materials &amp; Methods: The material for the study was taken from the cases attending thesurgery OPD and admitted In-patients of all the units of the Department of General Surgery, Navodaya Medical College Hospital &amp; Research Centre,whowerediagnosed to haveChronicanal fissure. This study was a prospective study which included 90 patients presenting with chronic anal fissure over a period of 18 months from November 2019 to May 2021.Thesepatientswererandomly selectedandclassifiedintothree groups(A,B,C) eachconsistingof30 patients &amp; each group with one type of treatment modality, like group A for 2% diltiazem, B for lords anal dilatation &amp; C for LIS. Follow-up of the patients was done by history and per-rectalexamination to assess the efficacy of the treatment and the complications like pain,bleeding,sphincter spasm, dischargeperanum and incontinence. Results :This study showed the results in favour of Lateral Internal Sphincterotomywith a healing rate of 100% with faster pain-relief and minimal or no complications ifperformedbythehands of an experienced surgeon, whereas latency in the clearance of symptoms and lesions was seen with 2% Diltiazem and Lords Anal Dilatation with adverse effects as well. With the healingrate of 100% of Fissure-in-ano in LIS therapy group, 81% in Lords Anal Dilatation and 71% with topical 2% Diltiazem therapy, &amp; adverse effects or complications being maximum in 2% Diltiazem therapy group, 13 patients (46%) when compared to Lords Anal Dilatation (41% , 11 patients) and LIS group (32%, 09 patients), weconcludethatLateralinternalsphinterotomy(LIS) appearstobethebetterlineoftreatmentasthereis 100%healingrate, minimal complications and no recurrence.

Management of chronic fissure in ano-lateral internal sphincterotomy versus 2% diltiazem gel local application: a prospective comparative study

Background: Fissure-in-ano is one of the most common benign anorectal disorders often encountered in surgical outpatient department. Various pharmacological agents and surgical interventions have been tried in the management of fissure in ano. In this study we have compared medical management by topical diltiazem gel with established surgical procedure of lateral internal sphincterotomy (LIS) in the management of chronic anal fissure. Methods: A total of 50 patients with chronic fissure in ano involved in this prospective comparative study, between December 2020 to May 2022, at Rajarajeswari Medical College and Hospital, Bengaluru. Selected patients were put under two groups of 25 participants each, A (2% diltiazem group) and B (lateral internal sphincterotomy - LIS group) using simple randomization technique and were to receive treatment accordingly. Fissure healing and pain relief were recorded on presentation and during follow up visits. Results: The results were compared weekly for 4 weeks and monthly for 2 consecutive months. Fissure healing and pain relief were recorded. Conclusions: Both 2% diltiazem group and LIS group are equally effective and did not show any difference in pain relief or fissure healing with p value not significant (&gt;0.05).

Management of Chronic Anal Fissure with a Novel Topical Hemp-Herbal-Based Ointment: A Pilot Study

Introduction: Anal fissure (AF) is a common anorectal disease. Although several pharmacological treatments are available, many patients still require surgical interventions. In this study, we aimed to evaluate the efficacy of an ointment based on a multifunctional blend of herbal ingredients including hemp (ProctoFiz) for chronic AF. Methods: A single-arm, questionnaire-based prospective study was conducted in a large tertiary center to evaluate the outcomes of patients suffering from chronic AF treated with topical ProctoFiz. Results: Ninety-two patients were included in the study, 54 (58.7%) were females with a median age of 39 (range 17–78). 32 patients (34.7%) suffered from recurrent AF before enrolling in the study, and 5 patients (5.4%) underwent previous surgical interventions for AF. Three patients (3.2%) were lost to follow-up, leaving 89 patients for analysis. Eighty patients (89.9%) reported significant improvement of symptoms after 1 week using ProctoFiz, and 79 patients reported continued improvement after 1 month of treatment. The mean pain Visual Analog Score (VAS) declined by 6.6 points (8.9 vs. 2.3; 95% CI: 7.20 to −5.99, p < 0.0001) following 1 week of treatment, with continuous improvement to a mean of 0.64 after 1 month. Negative impact on quality of life significantly decreased from a mean of 8.8 to 0.38 following a month of treatment (p < 0.0001), with significant reduction in the number of patients suffering from bleeding following bowel movements (64.1–2.5%; p = 0.0001). Conclusion: Hemp-based topical treatment of AF is feasible and significantly improves AF-correlated symptoms.

Glyceryl trinitrate cream versus lateral sphincterotomy in management of chronic anal fissure: a prospective randomized comparative study

Glyceryl trinitrate cream versus lateral sphincterotomy in management of chronic anal fissure: a prospective randomized comparative study

Comparing Outcomes of Lateral Internal Sphincterotomy, Botulinum Toxin Injection and Laser Therapy in the Management of Chronic Anal Fissure

Comparing Outcomes of Lateral Internal Sphincterotomy, Botulinum Toxin Injection and Laser Therapy in the Management of Chronic Anal Fissure

Comparative Study between Medical and Surgical Management of Chronic Anal Fissure

Comparative Study between Medical and Surgical Management of Chronic Anal Fissure

Comparative Study of Glyceryl Trinitrate (GTN) Ointment Versus Lateral Internal Sphincterotomy in Management of Chronic Anal Fissure

Objectives: To compare the effectiveness of 0.2% glyceryl trinitrate ointment versus lateral sphincterotomy in management of patients with chronic anal fissure. Materials and Methods: This Comparative study was done in Irfan general hospital THQ Charsadda, and the duration of this study were from April 2022 to September 2022. In this study 80 patients with anal fissure were enrolled. All the patients were divided into two group by lottery method. Group A patients were treated by lateral sphincterotomy while group B was treated by ointment of 0.2% glyceryl trinitrate. A predesign questionnaire were used to collect data. Results: Total 80 patients were enrolled equally divided in to two groups. Group A had 29 (72.5%) male and 11 (27.5%) female while group B had 23 (57.5%) male and 17 (42.5%) female with mean age of 40.47±10.94 years. Group A had 18 (45%) mild pain and 22 (55%) had severe pain while group B had 19 (47.5%) mild pain and 21 (52.5%) severe pain. 23 (57.5%) and 25 (62.5%) patients had bleeding before treatment. The final comparison after 6 weeks of treatment shows the 65% of patients healed with the lateral sphincterotomy and 52.5% of patients healed with ointment of glyceryl trinitrate. The healed proportion was measured high for the lateral sphincterotomy treatment as compared to the ointment of GTN. Practical implication: In our study we find that lateral sphincterotomy is more effective so this study will help the clinical practioner to select the better treatment option inorder to cure the anal fissure soon. Conclusion: It is concluded that for the treatment of anal fissure, the lateral sphincterotomy is considered an effective treatment as compared to ointment of GTN. Keywords: Chronic anal fissure; Glyceryl trinitrate ointment; Lateral internal sphincterotomy

Pelvic floor physical therapy in the treatment of chronic anal fissure (PAF trial): quality of life outcome.

Chronic anal fissure is one of the most common anorectal diseases and is associated with reduced quality of life. The aim of this study was to investigate the effects of pelvic floor physical therapy on quality of life in patients with chronic anal fissure using the Short-Form 36 Health Survey (RAND-36). Adult patients, with chronic anal fissure and concomitant pelvic floor dysfunction, such as dyssynergia and increased pelvic floor muscle tone, were recruited at the Proctos Clinic in the Netherlands, between December 2018 and July 2021 and randomly assigned to an intervention group, receiving 8weeks of pelvic floor physical therapy or assigned to a control group receiving postponed pelvic floor physical therapy (PAF trial). Quality of life and pain ratings were outcomes of the study and were measured at 8- and 20-week follow-up. One hundred patients (50 women and 50 men, median age 44.6years [range 19-68years]), completed the RAND-36 questionnaire and visual analog (VAS) pain scale score at admission. A significant improvement was found at 20-week follow-up in all domains of the RAND-36; physical functioning, pain, health change (p < 0.001); physical role, vitality, general health, social functioning, emotional role, mental health (p < 0.05). VAS pain was significantly reduced at 8weeks (mean estimated difference 1.98; 95% CI 1.55-2.42, p < 0.001) and remained significant at 20-week follow-up (p < 0.001). The difference between the groups as regards change in the mean pain intensity scores at 8weeks was 2.48 (95% CI -3.20 to -1.75; p < 0.001). Compared to the reference values of the general Dutch population, the patients in our study with a chronic anal fissure and pelvic floor dysfunction reported an impaired quality of life in 8 of 9 domains of the RAND-36. After treatment, significant lower scores were found in 2 out of 9 domains. The results of this study provide evidence that treatment by pelvic floor physical therapy improves quality of life and reduces pain, making it an important tool in management of chronic anal fissure and concomitant pelvic floor dysfunction.

The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Anal Fissures.

The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Anal Fissures.

Comparative Study Between Fissurectomy and Lateral Sphincterotomy Versus Fissurectomy and Anal Dilatation in Management of Chronic anal Fissure

Comparative Study Between Fissurectomy and Lateral Sphincterotomy Versus Fissurectomy and Anal Dilatation in Management of Chronic anal Fissure

Comparative Study Between Closed Versus Open Internal Sphincterotomy for Management of Chronic Anal Fissure

Comparative Study Between Closed Versus Open Internal Sphincterotomy for Management of Chronic Anal Fissure

Review of Medical and Surgical Management of Chronic Anal Fissure

To determine which treatment modality has the best outcome for chronic anal fissures in terms of pain relief, fissure healing, and recurrence. The main symptoms are pain while the passage of stools is acute in primary fissures but often persists in case of longstanding fissures causing significant discomfort to the patient. The management of anal fissure has progressed immensely in the last decade due to a better understanding of its pathophysiology. The main aim of the treatment is to reduce the spasm of the internal anal sphincter, thereby reducing the anal canal pressure. The Conservative approach consists of topical nitrates, calcium channel blockers, and calcium channel blockers. It is often preferred over surgical alternatives as it is not invasive. Surgeries for chronic anal fissures include anal dilatation, posterior mid-line sphincterotomy, lateral internal sphincterotomy, fistulectomy, sphincterolysis, and advancement flap repair. This narrative review article aims to review all the existing and newer complex modalities available for the management of chronic anal fissures. Currently the initial management of fissures is pharmacological therapy with topical nitroglycerin or diltiazem or botulinum toxin A injection. The following line of treatment is surgical, which is lateral internal sphincterotomy. Non-surgical therapy often proves ineffective in providing relief and healing, frequently culminating in the recurrence of fissures. On the other hand, surgical therapy has postoperative drawbacks like intestinal incontinence, commonly gas, loose stool or rarely hard stool. There is inadequate data on the latest treatment modalities like fistulotomy, sphincterolysis, flap procedures, etc. They may be considered only when conventional therapy fails to provide relief.

Real World Outcomes of Lateral Internal Sphincterotomy vs Botulinum Toxin for the Management of Chronic Anal Fissures

Journal of the American College of Surgeons: November 2021 - Volume 233 - Issue 5 - p S63 doi: 10.1016/j.jamcollsurg.2021.07.109

Outcomes of Fissurectomy and Advancement Flap in Management of Chronic Anal Fissure

Chronic anal fissure is a painful linear tear in the mucocutaneous junction of the distal part of the analcanal and involves the full thickness of mucosa, causing severe pain may last even hours after defecation.Usually,it occurs along the midline either anterior or posterior,if it presents off the midline, other pathologymight be associated with. Unhealed anal fissure after 6-8 weeks is defined chronic, with the presence of othercriteria,it unlikely heals with medical treatment, and surgery is mandatory after pharmacological treatmentfailure. Lateral internal sphincterotomy had high healing rate, but unfortunately, with risk of incontinence.Fissurectomywithcomplete excision of the fissure keeping the internal anal sphincter intact,and anadvancement flap of well vascularized tissue is transferred to cover the base of fissure and improve healing.This study mainly aiming to analyze the outcome of fissurectomy with advancement flap procedure in thetreatment of chronic anal fissure and highlight its advantage in terms of healing rate and complicationsespecially anal incontinence.During a period of about 5 years 345 patients (260 males and 85 females), havebeen included in this study and were diagnosed as cases of chronic anal fissure. After administration of localanesthetic,fissurectomywith advanced flap was performed. Patients had been followed up regularly for 6-24months. Data collected and statistical analysesby using SPSS. About 75% ofpatients were males while, 25% were females, their ages were between 20-59 year, most of the patients werein thirties, nevertheless most of the females were in twenties.Mean time for wound healing was 10 days.Whilst complete fissure healing process lasting approximately one month. About 11.9% of the patients takemore than one month to complete healing process. Healing rate was 100% after the follow up period of 6-24months. Recurrence developed only in 2% of the patients. None of the patients developed incontinence,anal stenosis, key hole deformity, necrosis or urine retention. From this study concluded Fissurectomy withadvancement flap in the treatment of chronic anal fissure is cost effective procedure, can be done under LAwith least time-off work, with low complication, low recurrence,and no incontinence.