Surgical Treatment Of Anal Fissure Research Articles

Open vs. Closed Sphincterotomy for Surgical Treatment of Anal Fissures

There is currently no specific evidence regarding the exact etiology of anal fissures. However, various management options were reported and validated among the relevant research. Lateral internal sphincterotomy has been validated among relevant investigations in the literature as a valid modality for managing patients with chronic anal fissures. In the present literature review, we formulated evidence based on these studies to compare open and closed techniques of this surgery according to the reported outcomes. However, evidence regarding the superiority of either of the techniques over the other is not consistent among these investigations. For instance, some studies reported that closed sphincterotomy is more favorable than the open approach and should be considered the treatment choice for chronic anal fissures. This is because the technique is associated with less frequent rates of complications, less expensive, safe, and effective. On the other hand, many other relevant studies also demonstrated that the reported outcomes for the two modalities exhibited non-significant differences. Therefore, we suggest that researchers should furtherly conduct additional investigations before drawing any conclusions in this field.

Results of surgical treatment in chronic anal fissure complicated by abscess or fistula in a retrospective cohort of patients

We report the results of the surgical treatment of anal fissures complicated by abscess or fistula and formulate hypotheses about their nature. Among patients operated between 2012 and 2020 for anal fissure resistant to medical therapy, those affected by septic complications were selected for our inquiry. Surgical treatment consisted in the drainage of the sepsis, fissurectomy, posterior sphincterotomy and anoplasty. Intra-sphincteric fistulas were removed with the fissure, whereas low trans-sphincteric tracks, including horseshoe fistulas, were partially opened and curetted. Patients were followed on post-operative days 7-10 and then until healing. Pre- and post-operative Visual Analog Scale (VAS) and Cleveland Clinic Incontinence Score (CCIS) scores were compared. Recurrence rates of disease were recorded. We operated 988 patients and 55 of them showed local sepsis (5.5%) complicating anal fissures. There were 23 abscesses and 32 fistulas. Of these latter, 17 were intra or inter-sphincteric (2 anterior) and 15 low trans-sphincteric (6 horseshoes). Pre-operative VAS score was 7.6 ± 0.9 (mean ± sd), CCIS was 0.1 ± 0.5. Complete healing occurred after a median of 6weeks (range 3-14weeks). Mean VAS score dropped to 2.3 ± 0.6 at first follow-up visit and CCIS rose to 0.4 ± 0.2. After a mean of 56.4months, 41 patients agreed to a visit and 14 were interviewed by phone. At office visit no disease recurrences were observed; pain and continence scores were within normal ranges in all patients. Abscess and fistula in anal fissures are not frequent and may represent a different disease from cryptoglandular fistulas. Surgical treatment achieves higher success than that reported for cryptoglandular fistulas.

Treatment Algorithm for Anal Fissure. Consensus Document of the Spanish Association of Coloproctology and the Coloproctology Division of the Spanish Association of Surgeons

The Spanish Association of Coloproctology and the Coloproctology Division of the Spanish Association of Surgeons propose this consensus document with a treatment algorithm for anal fissure that could be used for decision making. Non-surgical therapy and surgical treatment of anal fissure are explained, and the recommended algorithm is provided. The methodology used was: creation of a group of experts; search in PubMed, MEDLINE and the Cochrane Library for publications from the last 10 years about anal fissure; presentation at the 21st National Meeting of the Spanish Association of Coloproctology Foundation 2017 with voting for/against each conclusion by the attendees and review by the scientific committee of the Spanish Association of Coloproctology.

Tratamiento de la fisura anal: algoritmo de actuación. Documento de consenso de la Asociación Española de Coloproctología y la Sección de Coloproctología de la Asociación Española de Cirujanos

The Spanish Association of Coloproctology and the Coloproctology Division of the Spanish Association of Surgeons propose this consensus document with a treatment algorithm for anal fissure that could be used for decision making. Non-surgical therapy and surgical treatment of anal fissure are explained, and the recommended algorithm is provided. The methodology used was: creation of a group of experts; search in PubMed, MEDLINE and the Cochrane Library for publications from the last 10 years about anal fissure; presentation at the 21st National Meeting of the Spanish Association of Coloproctology Foundation 2017 with voting for/against each conclusion by the attendees and review by the scientific committee of the Spanish Association of Coloproctology.

Delayed fecal incontinence following surgery for anal fissure

The surgical treatment of chronic anal fissure is basically done by therapeutic controlled damage to the internal anal sphincter. While fecal incontinence is a well-documented early complication of anal fissure surgery, few data are available about delayed incontinence. The aim of the present study was to assess whether surgical treatment of anal fissures may contribute to the development of delayed anal incontinence. A retrospective review of patients referred to the Pelvic Floor Laboratory for physiological evaluation of anal incontinence between 1992 and 2009. All patients, diagnosed with anal fissures, who underwent anal dilatation or partial lateral internal sphincterotomy and developed incontinence at least 4years after the surgery were included. Controls were patients with delayed anal incontinence after obstetric injury. A total of 21 patients with delayed post-anal fissure surgery incontinence (nine women and 12 men) were identified. The mean (SE) age of incontinence onset in this group of patients was 51.5 (±2), which was 8years younger than the rest of the 363 incontinent patients (p < 0.001). Time from presumed anal sphincter damage to the onset of incontinence was significantly shorter in the group of past anal-fissure-surgery patients compared to post-obstetric trauma patients (mean difference 15years, p < 0.001). The severity of incontinence was higher in post-obstetric trauma patients. Fecal incontinence may present as a late complication of anal fissure surgery. Incontinence may be associated with other cofactors accumulating over time or, more likely, anal fissure surgery may accelerate the physiologic age-related weakening of the anal sphincter mechanism. Candidates for anal fissure surgery should be informed regarding this possible outcome.

Surgeons’ Beliefs and Experiences with the Surgical Treatment of Anal Fissure

Surgeons’ Beliefs and Experiences with the Surgical Treatment of Anal Fissure

Surgical Treatment of Anal Fissure

Surgical Treatment of Anal Fissure

裂こうに対する治療法の工夫 ＩＶ．裂こうの外科的治療

裂肛は硬便などの通過により肛門上皮に生じた裂創で,慢性化してくると肥大乳頭,見張り疣をともない,肛門狭窄をきたして難治となる.裂肛の治療方針は基本的には保存的治療であるが,軽快しない慢性裂肛は,外科的治療の適応となる.外科的治療法には用手肛門拡張術(AD),側方内括約筋切開術(LSIS),皮膚弁移動術(SSG)がある.明らかな肛門狭窄を呈する症例は,ほとんどLSISの適応となるが,全周性の多発裂肛が原因でおこる肛門上皮の瘢痕により肛門狭窄を生じたものや不適切な肛門手術による高度の肛門狭窄をともなうものに対してはSSGが適応となる.外科的治療の際,術式はその適応を十分に検討したうえで決定されるべきである.

Botulinum toxin A in the treatment of anal fissure

This paper presents our first experience in the treatment of primary anal fissure by injection of botulinum A toxin into the internal sphincter. The study group of the retrospective study included 12 outpatients (8 females and 4 males), mean age 42 (range 18-60). During the period 2000-2003, after unsuccessful conservative treatment, patients were treated with the injections of botulinum A toxin, 100 units on both sides of the anal fissure laterally into the internal anal sphincter (50 units on either side). The patients were clinically evaluated 3, 7, and 30 days, and 3 and 6 months after the treatment. Three fissures had healed after a month, and seven after 3 months. Two remained unhealed, but asymptomatic. There was no incontinence of flatus or faeces after 3 months of the treatment. After temporary healing, two fissures relapsed after 6 months, and these patients had the adequate tonus of the anal sphincter muscles. Except for the temporary incontinence, there were neither other side-effects, nor serious complications. Injection of botulinum A toxin achieved good results in the treatment of anal fissure. The appropriate use makes this method safe as an alternative to surgical treatment of anal fissure.

Chronic anal fissures treated with botulinum toxin injections: a dose‐finding study with Dysport®

Botox(®) injection of the anal sphincter muscle cures chronic uncomplicated anal fissures in up to 80% of patients. This study examines the therapeutic efficacy and side effect profile of the British botulinum product Dysport(®) . Fifty patients (29 women) were recruited to participate in this randomized dose-finding study, their mean age being 32.9 years. The low dose group A was treated with a total dose of 20 U injected in two sites each lateral to the fissure, the high dose group B was treated with 40 U. Eighty-two percent of patients were pain-free within a week following the injections. The fissure was healed in 78% of treated patients after 3 months. Three patients relapsed within 6 months. The most common adverse side effect was transient incontinence (n = 4). Clinical outcome was not significantly different between the two treatment groups. The low dose can therefore be regarded sufficient for the treatment of anal fissure. Therapeutic efficacy was equivalent to published data on Botox treatment. Both Dysport(®) and Botox(®) can therefore be used to treat chronic uncomplicated anal fissures. Both Dysport(®) and Botox(®) therapy are well tolerated, can be performed on an out-patient basis and avoid the risk of permanent faecal incontinence which complicates surgical treatment of anal fissures.

Anal fissure in Crohn's disease

This study was undertaken to identify clinical characteristics, natural history, and results of medical and surgical treatment of anal fissures in Crohn's disease. This is a retrospective review of patients with Crohn's disease and anal fissure. Of the 56 study patients, 49 (84 percent) had symptomatic fissures. Fissures were most commonly (66 percent) located in the posterior midline, and 18 patients (32 percent) had multiple fissures. Fissures healed in one-half of patients treated medically. Factors predictive of successful medical treatment included male gender, painless fissure, and acute fissure. Of 15 patients, 10 (67 percent) treated surgically healed. Fissures in seven of eight patients (88 percent) who underwent anorectal procedures healed compared with fissures in only three of seven patients (43 percent) who underwent proximal intestinal resection. In the group of 50 patients with complete follow-up studies, an anal abscess or fistula from the base of an unhealed fissure developed in 13 patients (26 percent). More fissures healed after anorectal surgery (88 percent) than after medical treatment alone (49 percent; P = 0.05) or after abnormal surgery (29 percent; P = 0.03). This series documents that unhealed fissures frequently progress to more ominous anal pathologic disease. Judicious use of internal sphincterotomy appears to be safe for fissures unresponsive to medical treatment.

V. Surgical Treatment of Anal Fissure

Because inflammatory changes more progress and various complicated lesions are caused as anal fissure becomes chronic, accurate diagnosis of the complicated lesions shoud be made and treatment shoud be selected. There are many reports on surgical treatments and each surgical treatment is evaluated definitely. However, there still remain method's, such as the laternal sphincterotomy, which requires further investigation. Many cases are cured easily by the conservative techniques which remove spasm of the internal sphincter, and therefore, it doesn't seem to be necessary to decide only one specific method. However, it can be said that the sliding skin graft is the best radical plastic opreation for the progressive cases.

4.Surgical Treatment of Anal Fissure

Anal fissure is very common disease and shows various symptoms. However, its treatment still not invariably.Author displayed diagram that indicates relation of the advancement and correct treatment on anal fissure.On surgical procedure, author recommended cryosurgery and sliding skin graft combined with internal anal sphincterotomy.

An evaluation of the surgical treatment of anal fissures.

The best surgical treatment for anal fissure has yet to be identified. However, it does seem that closed three-quadrant hemorrhoidectomy in combination with some other form of surgical maneuver and superficial sphincterotomy results in a lower recurrence rate. It is most important that the operation chosen be suited to the need of the patient, however. It is suggested that the more complicated surgical procedures for treating anal fissures be reserved for those patients whose recurrences do not respond to simpler forms of treatment.