Chronic Anal Fissure Patients Research Articles

Comparison of outcome of botulinum toxin injection with and without glyceryl trinitrate in chronic anal fissure in terms of post operative pain and healing.

To compare the outcome of botulinum toxin injection with and without glyceryl trinitrate with respect to postoperative pain and healing in the treatment of anal fissures. The prospective, comparative study was conducted at the Department of General Surgery, Mayo Hospital, Lahore, Pakistan, from September 1, 2021, to August 31, 2022, and comprised adult chronic anal fissure patients of either gender. They were randomised using the lottery method into group A which received botulinum toxin injection, and group B which received botulinum toxin injection plus 1g of 0.2% topical glyceryl trinitrate cream. Post-operative pain was measured 24 hours after the procedure using the visual analogue scale. Healing was assessed by examining the wound for the appearance of granulation tissue 4 weeks post-procedure. Data was analysed using SPSS 26. Of the 88 patients, 44(50%) were in group A; 32(72.7%) males and 12(27.3%) females with mean age 33.91±14.8 years. There were 44(50%) patients in group B; 35(79.5%) males and 9(20.5%) females with mean age range 36.33±14.9 years. The mean postoperative pain at 24 hours in group A was 4.67±1.16 and it was 3.06±0.65 in group B (p=0.009). In group A, 23(69.7%) patients showed complete healing at 4 weeks compared to 30(90.9%) in group B (p=0.030). Botulinum toxin injection with glyceryl trinitrate could be considered as first line of treatment for chronic anal fissure in patients who refuse surgery and with previous sphincter surgery.

COMPARATIVE STUDY ON THE EFFICACY OF TOPICAL METRONIDAZOLE, TOPICAL NITROGLYCERINE, AND TOPICAL DILTIAZEM IN THE MANAGEMENT OF CHRONIC ANAL FISSURE

Background and Aims: Chronic anal fissure (CAF) is usually managed with surgical modalities but it imposes huge cost with recurrence rates. Hence, topical therapies are preferred is such cases which has a good patient acceptability rate. The present study aims to compare the topical metronidazole (MTZ), diltiazem (DTZ), and glyceryl trinitrate (GTN) in terms of healing rate and pain reduction in CAF patients. Methods: This was a randomized and prospective study conducted on 90 patients with CAF. The patients were grouped as follows (n=30), Group 1; 1% MTZ gel, Group 2; 0.2% Nitroglycerin ointment, and Group 3 (n=30): 2% DTZ ointment. The patients were evaluated at 2, 4, and 6 weeks for pain using visual analogue score (VAS) and healing rate. The results were compared and p<0.05 was considered as significant. Results: The VAS scores between the groups was found to be non-significant (p>0.05), however the VAS scores where markedly reduced within the group at 6 weeks. The healing rate was higher in MTZ group (90%) as compared to GTN (83.3%) and DTZ group (83.3%) but it was not significant. Regarding side effect, burning sensation was observed in MTZ and GTN, DTZ groups were devoid of side effects. Conclusion: The MTZ was more effective with good healing rate but with few side effects. Regarding the pain reduction, all the groups displayed equivocal effects. Thus topical MTZ is a suitable agent for the faster healing of CAF and thus avoids the requirement of surgical options.

Botulinum toxin as a promising surgical strategy for chronic anal fissure: do the dose and injection site matter? Comparison of doses and injection sites of botulinum toxin for chronic anal fissure: A systematic review and network meta-analysis of randomized controlled trials

Chronic anal fissure (CAF) often shows a considerable reluctance to heal for the hypertonia and spasm of the internal sphincter. CAF pain is very intense and sharp and always described as tearing, knife-cut or passing broken glass. Lateral internal sphincterotomy remains the preferred treatment modality of all surgical options with high healing rates ranging from 88 to 100%, followed by incontinence rates ranging from 8 to 30% which can have a significant impact on a person’s quality of life.1 Botulinum toxin (BT) has been widely used in the treatment of CAF due to its ability to promote healing and lower risk of incontinence. However, there is still no consensus on the BT dose and injection site which are associated with the curative effect. Vitoopinyoparb et al.2 performed a systematic review and network meta-analysis of randomized controlled trials and identified that low-dose (≤20 U) BT was optimal, and injection out of the fissure site improved short-term outcomes while injection each side of the fissure site tended to reduce recurrence in the long run. It is of great interest to provide a relatively standard protocol to guide anorectal surgeons in the management of BT. BT, as a temporary chemical sphincterotomy, can lead to the blockade of acetylcholine release and cause short-term paralysis of internal sphincter muscle to reduce the anal tone. Based on our clinical experience, the higher the BT dose (within 100 U in general), the higher the healing rate of CAF. According to the survey conducted by the American Society of Colon and Rectal Surgeons, dose above 50 U of BT appeared to correlate with higher success rate and healing rate.3 Maria et al.4 has confirmed that higher doses can improve the healing rate without increasing complications or side effects. However, a meta-analysis including 18 clinical trials concluded that the healing rate decreased with the increase of the BT dose (P=0.048), but the incontinence rate (P=0.048) and recurrence rate (P=0.002) increased slightly with the increase of the BT dose5. Another meta-analysis involving 1577 patients from 34 prospective studies showed that the healing rates ranged from 33 to 96% the BT with the reported BT doses ranging from 5 to 150 IU across the analyzed studies. However, there was no correlation between postoperative healing rate and BT dose (P=0.0708), and the rates of postoperative complications and fecal incontinence were not found to be in a dose-dependent manner.6 Conflicts over BT dose selection often cause confusion among anorectal surgeons. In this network meta-analysis, Vitoopinyoparb and colleagues found that low-dose (≤20 U) BT was optimal based on 27 randomized controlled trials, providing high-level evidence on this regard. Based on the existing knowledge, most studies recommend injecting BT into internal sphincter in three or four quadrants around the anal canal. We also believe that BT should be injected into the internal sphincter because the fundamental pathogenic is hypertonia and spasm of the internal sphincter in CAF. As Brisinda et al.4 said, the internal sphincter is readily visible and easier to inject than the external sphincter. To improve the healing rate, we usually inject the BT both outside the fissure and on each side of the fissure. A study which included 50 CAF patients showed that injections on both sides of the anterior midline were more effective than those on the posterior midline.7 In this study, the short-term healing rate of external injection was better than that of both sides of the fissure, while the long-term recurrence and incontinence of bilateral injection were less.1 In general, we believe these results of this study have high value for clinical application, and large multicenter randomized controlled studies should be advocated to further confirm the findings. Ethical approval Not applicable. Sources of funding This study is funded by the Shenkang Clinical Three-Year Action Plan (major research) (grant no. SHDC2020CR2007A), and the National Natural Science Foundation of China (81774112). Authors’ contribution H.X.: design and write the commentary. W.Y.: review the commentary. Z.M.: design, review, and revise the commentary. Conflicts of interest disclosure The authors declare that they have no financial conflict of interest with regard to the content of this report. Research registration unique identifying number (UIN) None. Guarantors Zubing Mei, Hao Xu.

L-Arginine is a feasible supplement to heal chronic anal fissure via reducing internal anal sphincter pressure: a randomized clinical trial study.

The hypertonicity of internal anal sphincter resting pressure is one of the main causes of chronic anal fissure. Therefore, the aim of this study was to assess the effect of oral administration of L-arginine on the improvement of the anal fissures by relaxing the internal anal sphincter. Seventy-six chronic anal fissure patients (aged 18-65years) who were referred to Rasoul-e-Akram Hospital, Tehran, Iran from February 2019 to October 2020 participated in this randomized, double-blind, placebo-controlled trial. Participants were allocated into treatment (L-arginine) and placebo groups. They took a 1000mg capsule three times a day for 1 month, and then we followed them at the end of the first and third months after the intervention. Clinical symptoms, anal sphincter resting pressure, and quality of life (QoL) were completed at baseline and the end of the study. The analysis of data showed a significant decrease in bleeding, fissure size, and pain for each group; however, in the L-arginine group was more than the control group at the end of the study (P values < 0.001). Following that, a significant increase in QoL was seen just in patients treated with L-arginine (P value = 0.006). In addition, the comparison of anal pressures at baseline and, between groups at the end of the study showed a significant reduction in sphincter pressure in patients treated with L-arginine (P value < 0.001, = 0.049; respectively). The oral administration of 3000mg L-arginine can heal chronic anal fissures by reducing internal anal sphincter pressure with more negligible side effects. However, we recommend long-term study with more extended follow-up.Clinical trial registry: IRCT20190712044182N1 at Iranian clinical trials, date: 2019-08-27.

Depression and anxiety among chronic anal fissure patients

Introduction/Aims: Anal fissures are common disorders characterized by extreme pain, difficult defecation, and altered quality of life. The etiology of such condition is not entirely elucidated as it is implicated that stress could be an etiologic factor of anal fissures. Therefore, this study aims to evaluate the mental health of patients with chronic anal fissures in an effort to demonstrate the link between psychiatric disorders and anal fissures. Methodology: All patients clinically diagnosed with chronic anal fissures attending the surgery clinics were recruited prospectively into this study over a 4-month period (from October 2020 to February 2021). During the clinic visit, patients were examined for chronic anal fissures as well as evaluated for depression, anxiety, and sleep disturbances using the PHQ-9, GAD-7, and PSQI scores pre and post the 3-months treatment period. ResultsThis study included a total of 51 patients clinically diagnosed with chronic anal fissures. The sample has an average age of41.8 ± 14.5 years and an average time of 7.1 ± 22.1 months since the start of their symptoms. The most frequent symptoms across the sample included pain while defecating (92.2%), severe constipation (52.9%), and bloody stool (45.1%).During follow up after 3 months treatment, our analysis showed that the means of PHQ9, GAD7, and PSQI scores were significantly lower than at diagnosis (pre-treatment) (All, p < 0.01).Moreover, pain intensity, distress, and interference means were all significantly lower than their values prior to treatment (All, p < 0.01). ConclusionWe concluded that the quality of life for patients with chronic anal fissures is impacted by pain, psychiatric disorders and sleep disturbances. Therapy should be attainable, cheap, effective and focused on enhancing sleep alterations, in addition to targeting psychiatric symptoms.

Outcome of Bilateral Segmental Internal Anal Sphincterotomy for Treatment of Chronic Anal Fissure

Background: Chronic anal fissures are harder to treat, and surgery may be the best option. The goal of surgery is to help the anal sphincter muscles relax which reduces pain and spasms, allowing the fissure to heal. Objective: The aim of the present study was to assess the improving outcome of patients of chronic anal fissure. Patients and methods: This study included 18 patients with chronic anal fissure admitted at Department of General Surgery, Faculty of Medicine, Zagazig University. All patients were subjected to full history taking, proper local examination and baseline investigations. Anorectal manometry was performed for all patients preoperatively and bilateral segmental internal sphincterotomy was done for all patients. Results: The present study showed that 88.9% had constipation, 100.0% had pain and 77.8% had bleeding defecation. Duration was distributed as 7.55 ±2.68 with minimum 4 and maximum 14 months and the majority were between 6-12 months. Complete healing was distributed as 5.16 ±1.09 with maximum 8 weeks. Visual Analogue Scale (VAS) significantly decreased from pre to 1st 24 hours tell the end of follow up . Incontinence score significantly decreased from pre to 1st week tell the end of follow up. Conclusion: It could be concluded that bilateral segmental internal sphincterotomy takes some extra time for the procedure and significantly a good procedure in treatment of chronic anal fissures in terms of early pain relief, reduction of resting anal pressure and complete healing rate in 5 weeks. The risks of incontinence and recurrence of fissure are negligible with superior patients’ satisfaction.

Use of Botulinum Toxin Injections for the Treatment of Chronic Anal Fissure: Results From an American Society of Colon and Rectal Surgeons Survey.

Chronic anal fissure (CAF) is commonly treated by colorectal surgeons. Pharmacological treatment is considered first-line therapy. An alternative treatment modality is chemical sphincterotomy with injection of botulinum toxin (BT). However, there is a lack of a consensus on the BT administration procedure among colorectal surgeons. A national survey approved by the American Society of Colon and Rectal Surgeons (ASCRS) Executive Council was sent to all members. An eight-question survey was sent via ASCRS email correspondence between December 2019 and February 2020. Questions were derived from available meta-analyses and expert opinions on BT use in CAF patients and included topics such as BT dose, injection technique, and concomitant therapies. The survey was voluntary and anonymous, and all ASCRS members were eligible to complete it. Responses were recorded and analyzed via an online survey platform. 216 ASCRS members responded to the survey and 90% inject 50-100U of BT. Most procedures are performed under MAC anesthesia (56%). A majority of respondents (64%) inject into the internal sphincter and a majority (53%) inject into 4 quadrants in the anal canal circumference. Some respondents perform concomitant manual dilatation (34%) or fissurectomy (38%). Concomitant topical muscle relaxing agents are not used uniformly among respondents. Injection of BT for CAF is used commonly by colorectal surgeons. There is consensus on BT dosage, administration site, technique, and the use of monitored anesthesia care.

Open lateral internal sphincterotomy safe option for chronic anal fissure. A clinical study

Objectives: To provide local data regarding the postoperative complications, pain, anal incontinence and recurrence after lateral internal sphincterotomy for chronic anal fissure. Study Design: Clinical Study. Setting: DHQ Charsadda. Period: May 2017 to December 2019. Material &amp; Methods: It was done on 230 chronic anal fissure patients who had underwent prior conservative treatment. Surgery for all patients was carried out under General anaesthesia with open sphincterotomy. Postoperative follow up was carried till 6 months. Data were collected and analysis by using SPSS version 23. Chi square test was used to compare at level of significance &lt;0.005. Results: Mean age of patients was 37.50 ± 7.28 years. Female presented with more postoperative complications than male but differences were statistically not significant. At the end of 6th months follow up period we observed that significantly higher numbers of patients were satisfied (91.4%) with a healing rate of (93.8%). Conclusion: LIS is treatment of choice for chronic anal fissure.

Efficacy of Diltiazem 2% Cream as a Solid Treatment of Patients with Chronic Anal Fissure at Kirkuk General Hospital

Background: Chronic anal fissure is a common painful benign anorectal case. Surgical operations like lateral internal sphincterotomy or manual anal dilatation are effective for healing most cases within a few weeks. However, as a side effect, permanent impaired anal .continence is likely to occur Aim: This article aims to evaluate whether the pharmacological can be the first-line option for .the treatment of chronic anal fissure Patients and Methods: 60 patients are enrolled with a chronic anal fissure in this work. The cases were chosen randomly from Kirkuk general hospital during the period from February 2017 to October 2018. As a first-line therapy, all patients treated with diltiazem 2% cream for .6 weeks Results: As a result of adverse drug reaction and uncooperative patients, 10 patients were unable to complete medical treatment, while 50 patients were able to complete it. Furthermore, 40 patients (out of 50) achieved complete recovery with 25 males and 15 females. Nevertheless, 10 patients (7 males and 3 females) were failed to reach complete recovery, which makes undergoing sphincterotomy as a second-line option. Complete recovery is achieved in (n=45) 90% of patients within 5-6 weeks from the start of diltiazem 2% cream. Whereas, 10% of them (n=5) recovered with complete 6 weeks administration of .the cream Conclusions: For majority patients with a chronic anal fissure, diltiazem 2% cream with a course of six weeks was the first-line choice therapy.

Comparison of the effectiveness of two treatment modalities for chronic anal fissure: Botox versus sphincterotomy.

Anal fissure is a common health problem that affects the quality of life of young patients. The aim of our study was to benchmark results of lateral internal sphincterotomy (LIS) and botulinum toxin injection in the treatment of chronic anal fissure. This multi-center, retrospective study used data from 135 chronic anal fissure patients. Patients' demographic features, clinical findings, fissure characteristics, post-defecation pain score, rectal bleeding or pruritus, and treatment satisfaction scores were recorded. Patients' data were collected from the hospital records and patients with all of this data available were called and invited to the hospital for examination. Seventy-four LIS and 61 botulinum toxin applied patients were included. Symptom duration, hospitalization period, and duration of remission of complaints after the treatment were significantly higher in the LIS group (p<0.001). However, pruritus in anus and relapses were found to be higher in the botulinum toxin group (p=¬ 0.04 and p= 0.043, respectively). Abscess and fistula were observed in one patient's perianal region in the LIS group, and an abscess was observed in one patient in the botulinum toxin group. There was no significant difference in treatment satisfaction rates and postoperative complications. Botulinum toxin yields satisfying results that are comparable to LIS. Patient selection may help mitigate this disease and allow it to be considered a good alternative option to surgery.

Closed Lateral Internal Anal Sphincterotomy Under Local Anesthesia for Treatment Of Chronic Anal Fissure: Our 10 Years Experience

Background: Chronic anal fissure is one of the most frequent proctological disorders worldwide. Closed Lateral Internal Sphincterotomy (LIS) is one of the therapeutic options accepted as the treatment of choice for Chronic Anal Fissure (CAF) as it reduces the hypertonia of the internal anal sphincter, decreases anal pain, and allows the fissure to heal. LIS can be done under general anesthesia or local anesthesia. Aim of this study was to see the post operative outcome of closed LIS done under local anaesthesia. Materials and methods : This retrospective study was conducted in Department of Surgery of Chattogram Medical College hospital and some private hospitals of Chattogram city from January 2008 to December 2017. Total 550 patients of CAF who underwent closed LIS under local anesthesia were included. Atypical fissures associated with other disease were excluded. Results: The mean duration of hospital stay was 3.38 ± 1.2 hours. Sentinel skin tag was excised in 296 patients. The fissure was posterior in 73.63% patients and anterior in 7.81% patients. Recurrence was noted in 1.3% patients within four months. 63.27% patients experienced normal continence except occasional lack of fecal control postoperatively and only one patient developed gross incontinence of solid and liquid stool. Conclusion : This study concluded that closed LIS under local anaesthesia is the procedure of choice for management of CAF as it is cost effective and time saving.&#x0D; JCMCTA 2018 ; 29 (2) : 53-56

Botulinum toxin improves pain in chronic anal fissure

IntroductionChronic anal fissure is a common condition associated with intense pain. Local botulinum toxin injection is a valid option in its management. The purpose of this study was to evaluate the efficacy of botulinum toxin on pain relief in chronic anal fissure patients. MethodsWe conducted a retrospective cohort study, involving 81 consecutive patients referred to a chronic pain management unit due to a chronic anal fissure for treatment with botulinum toxin, during a 4 year period. Data were collected from hospital records regarding pre-treatment and post-treatment pain (numeric rating scale), side effects, need for botulinum toxin reinjection and need for surgical treatment. We used standard statistical methods for inter (t-test and qui2) and intra-group (paired sample t-test) comparisons, according to variables distribution. ResultsPain intensity rest score significantly improved after BoNT injection [variation: −4.2±2.9 (p<0.001)], as did pain post-defecation score [variation: −5.1±3.0 (p<0.001)]. 8.6% needed botulinum toxin reinjection and 23.5% were submitted to surgery. Side effects were reported in 8.6%. DiscussionThe efficacy of botulinum toxin use on pain reduction along with its non-permanent and minor side effects support its role in the resolution of chronic anal fissure. However, treatment failure in the long term is still significant. ConclusionBotulinum toxin is effective on pain relief in patients with chronic anal fissure, which supports its inclusion in the management algorithm of this condition.

Stress and psychopathology and its impact on quality of life in chronic anal fissure (CAF) patients.

Chronic anal fissure (CAF) onset, exacerbation, and impact on quality of life are influenced by a host of psychological, physiological, and social factors. We aimed to investigate the difference in psychopathology and stress between normal and CAF groups. Thirty CAF patients and 20 age-sex matched healthy controls were evaluated for Axis I psychopathology, depression, anxiety, and stress with Hamilton and Hospital Depression-Anxiety Scales, Perceived Stress Scale, and SF-36. With a mean age of 39.47, 83.3% of CAF patients were female. Anxiety-depression and stress scores were all significantly higher and functionality was lower in the CAF group compared to controls (p<0.001); 36.7% of the patients had a triggering stress factor and 56.6% had an exacerbating stress factor; 56.7% of the patients had an ongoing Axis I psychopathology while 50% had a previous psychopathology. Pain (96.7% had pain (VAS = 6.55)) and bleeding (83.3% had bleeding (VAS = 4.14)) severity showed a negative impact on bodily pain and role limitations emotional subscales of SF36. There is a high comorbidity of psychopathology in the CAF patients and depression and anxiety severities show a negative impact on the quality of life. Stress acts as both a triggering and an exacerbating factor in CAF.

Comparative study of topical diltiazem with lateral internal sphincterotomy in management of chronic anal fissure

Introduction: Chronic anal fissure is persistent or recurrent painful linear ulcer situated in anal canal just below the dentate line to the anal verge and fails to heal within 6-8 weeks. For these fissures, partial lateral sphincterotomy is done which diminishes internal anal sphincter hypertonia and anal canal pressure but can lead to long term disturbances of sphincter function. In the present study we have compared medical management by topical diltiazem ointment with established surgical procedure of lateral internal sphincterotomy in the management of chronic anal fissure. Material and Methods: This was a prospective comparative randomised study, carried out on 100 patients of chronic anal fissure at S.M.S. Medical College, Jaipur. Intensity of pain was recorded on 0-10 Numeric Rating Scale and Wong-Baker Faces Pain Rating Scale (Visual analogue scale) on presentation and during follow up visits. Selected patients were put under two groups of 50 participants each, A (study group, diltiazem group) and B (control group, partial lateral sphincterotomy group) using simple randomization technique and were to receive treatment accordingly. Results: 26% patients of study group and 42% patients of control group reported no pain at 1st week of treatment. 72 % patients of study group and 94 % patients of control group reported no pain at 8th week of treatment. Conclusion: Topical diltiazem gel has shown to have several advantages and can be considered first line topical treatment but Partial lateral internal sphincterotomies still gold standard procedure for chronic anal fissure.

A Successful Case Series of 350 Chronic Anal Fissure Patients Underwent Laser Sphincterotomy in India

A Successful Case Series of 350 Chronic Anal Fissure Patients Underwent Laser Sphincterotomy in India

Topical Diltiazem Versus Topical Glyceryl Trinitrate In The Management Of Chronic Anal Fissure

Background: Chemical sphincterotomy is a novel way for treating patients of chronic anal fissure which avoids the risk of fecal incontinence associated with traditional surgical methods.&#x0D; Aims and objectives: The aim of this study was to compare the results of topical Diltiazem with topical Glyceril trinitrate in the management of chronic anal fissure.&#x0D; Methods: 71 patients in the age group of 15 - 61 years with chronic anal fissure were included in this prospective, randomized, double-blind trial over a period of two years with further follow up for one year. The patients were randomly allocated to either Diltiazem gel 2% (37 patients) or Glyceril trinitrate ointment 0.2% (34 patients) and were asked to use the treatment twice daily for 8 weeks. Each patient was reviewed every two weeks. Symptoms, healing, side effects and recurrence were compared using SPSS version 10 employing X2 test. A p-value below 0.05 was considered statistically significant.&#x0D; Results: Patients who received topical diltiazem (DTZ) showed statistically significant difference than those who were prescribed topical glyceril trinitrate in terms of symptoms, wound healing, side effects ( headaches) and recurrence (p=0.03 and 0.003 respectively). Healing occurred in 34 of 37 (92%) patients treated with Diltiazem after 6 weeks and 27 of 34 (80%) patients treated with Glyceril trinitrate after 8 weeks, which shows a significant difference in favour of Diltiazem (P &lt; 0.001). The rest of the patients did not heal and underwent sphincterotomy (SILS). Headache occurred in all of the patients treated with Glyceril trinitrate but none of the patients treated with Diltiazem.&#x0D; Conclusion: Diltiazem gel was found to be better than Glyceril trinitrate ointment due to significantly higher healing rate and fewer side-effects. JMS 2014;17(2):55-58

The effect of lateral internal sphincterotomy on resting anal sphincter pressures*

Anal fissures are one of the most common proctologic disorders. This study aimed to investigate alterations in anal sphincteric resting pressures after lateral internal sphincterotomy, which was performed for chronic anal fissure treatment. Fifty-six (68.3%) male and 26 (31.7%) female patients were included in this study. Patients complicated with fistula-in-ano, abscess, cancer, inflammatory bowel disease, dermatitis, poor general condition, allergy to any of the standard medications, previous history of anal trauma, previous anal surgery, or diagnosis of a neurological disease and patients who did not give consent to the trial were excluded from the study. Two groups were formed: a control group with 41 healthy volunteers and a study group with 41 chronic anal fissure patients. Preoperative and postoperative manometric anal measurements were compared. Preoperative mean resting anal sphincter pressure was 51.29 mmHg for the control group and was 59.99 mmHg for the patient group. Although resting anal sphincteric pressures of the patient group remained within the physiological range, when compared with the control group there was a statistically significant difference. Postoperative mean resting anal sphincteric pressures of the patient group was 32.43 mmHg. Lateral internal sphincterotomy decreases resting anal sphincter pressures effectively in chronic anal fissure patients.

Transcutaneous electrical posterior tibial nerve stimulation for chronic anal fissure: a preliminary study

Recent studies showed that sacral nerve stimulation might be an effective treatment option for chronic anal fissure. We aimed to evaluate the efficacy of transcutaneous electrical nerve stimulation as a noninvasive alternative treatment for chronic anal fissure by stimulating the sacral nerve in the ankle via the posterior tibial nerve. In this prospective study, transcutaneous electrical nerve stimulation was applied for 10 days in addition to conventional medical treatment in ten patients. Wexner's constipation score, visual analog scale for pain, quality of life (Short Form-36), Hamilton anxiety and depression scores, symptom relief, compliance, fissure healing, and side effects were evaluated before and after treatment (days 0, 5, and 10). Ten patients (eight females/two males) with a mean age of 50.7 ± 18.5 years were enrolled in the study. Pain and bleeding resolved in all patients 2 days after the treatment, and mucosal healing was observed in six patients 10 days after the treatment. Wexner's constipation and visual analog scale scores for pain decreased significantly (p = 0.001 and p = 0.002, respectively). Hamilton anxiety and depression scores decreased as well (p = 0.001 and p = 0.01, respectively). Among Short Form-36 subscales, only mental health score increased significantly (p = 0.003). One patient underwent surgery at follow-up due to recurrence of symptoms, and rubber band ligation was applied to another patient who had internal hemorrhoidal rectal bleeding at the end of 10 days. Transcutaneous electrical nerve stimulation application to the posterior tibial nerve has the potential to be an alternative treatment option for chronic anal fissure patients who seek noninvasive treatment modality.

A multi-center, randomized, double-blind, placebo-controlled trial of glyceryl trinitrate ointment in the treatment of anal fissure

To evaluate the clinical efficacy and safety of glyceryl trinitrate (GTN) ointment in the treatment of anal fissure. In this multi-center, randomized, double-blind and placebo-controlled trial, 240 chronic anal fissure patients from 7 clinical centers were randomized to receive eight-week treatment with GTN ointment (treatment group) or vaseline ointment (control group) respectively. Healing rate, visual analogue score (VAS), maximum anal resting pressure (MARP) and adverse reactions were recorded and compared. A total of 221 patients (92.1%) finished the trial, including 114 patients in treatment group (95.0%, 114/120) and 107 in control group (89.2%, 107/120). At the endpoint of treatment (56 d), 90 patients in treatment group (78.9%, 90/114) healed completely compared to 31 patients in control group (29.0%, 31/107), and decrease rates of VAS in the two groups were (94.8±15.7)% and (61.2±35.7)% respectively, both differences were statistically significant (P<0.01). MARP after first administration was (20.2±18.5) mm Hg in treatment group (n=12) and (7.1±14.7) mm Hg in control group (n=6), which was not significantly different (P=0.152). Adverse reaction incidence was higher in treatment group (42.1% vs. 9.3%, P<0.05), while these adverse reactions were mainly headache and fullness in head, which were self-limiting. GTN ointment can effectively promote healing and relieve pain in anal fissure with safety and tolerance.

Effect of botulinum toxin in selected chronic anal fissure patients: long-term results

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Karabulut Z, Doğan P, Moray G. Effect of botulinum toxin in selected chronic anal fissure patients: long-term results. Gastroenterology Review/Przegląd Gastroenterologiczny. 2012;7(6):383-385. doi:10.5114/pg.2012.33048. APA Karabulut, Z., Doğan, P., & Moray, G. (2012). Effect of botulinum toxin in selected chronic anal fissure patients: long-term results. Gastroenterology Review/Przegląd Gastroenterologiczny, 7(6), 383-385. https://doi.org/10.5114/pg.2012.33048 Chicago Karabulut, Zülfikar, Pașa Doğan, and Gökhan Moray. 2012. "Effect of botulinum toxin in selected chronic anal fissure patients: long-term results". Gastroenterology Review/Przegląd Gastroenterologiczny 7 (6): 383-385. doi:10.5114/pg.2012.33048. Harvard Karabulut, Z., Doğan, P., and Moray, G. (2012). Effect of botulinum toxin in selected chronic anal fissure patients: long-term results. Gastroenterology Review/Przegląd Gastroenterologiczny, 7(6), pp.383-385. https://doi.org/10.5114/pg.2012.33048 MLA Karabulut, Zülfikar et al. "Effect of botulinum toxin in selected chronic anal fissure patients: long-term results." Gastroenterology Review/Przegląd Gastroenterologiczny, vol. 7, no. 6, 2012, pp. 383-385. doi:10.5114/pg.2012.33048. Vancouver Karabulut Z, Doğan P, Moray G. Effect of botulinum toxin in selected chronic anal fissure patients: long-term results. Gastroenterology Review/Przegląd Gastroenterologiczny. 2012;7(6):383-385. doi:10.5114/pg.2012.33048.