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At least 19 recordsLinked to original sources
PubMed2001

Operative procedures for fissure in ano.

BACKGROUND: Operative techniques commonly used for fissure in ano include: anal stretch, open lateral sphincterotomy, closed lateral sphincterotomy, posterior midline sphincterotomy and to a lesser extent dermal flap coverage of the fissure. Reports of direct comparisons between operative techniques for anal fissure are variable in their results. These reports are either subject to selection bias (in non-randomized studies) or observer bias (in almost all studies) or have inadequate numbers of patients enrolled to answer the question of efficacy. OBJECTIVES: To determine the best technique for fissure surgery. SEARCH STRATEGY: MEDLINE and the Cochrane Library were searched using the key words: "surgery, anal fissure". Additional search terms such as "anal sphincterotomy" and "anal fissure therapy" disclosed no additional reports. The list of cited references in all included reports also was helpful in finding additional comparative studies. SELECTION CRITERIA: All reports in which there was a direct comparison between at least two operative techniques were reviewed and when more than one report existed for any given pair, that report was included. If crude data were not presented in the report, the authors were contacted and crude data obtained. DATA COLLECTION AND ANALYSIS: The two most commonly used end points in all reported studies were persistence of the fissure and post operative incontinence of flatus. These are the only two endpoints included in the meta-analysis. MAIN RESULTS: Anal stretch has a higher risk of fissure persistence than internal sphincterotomy and also a significantly higher risk of minor incontinence than sphincterotomy. The combined results of open versus closed partial lateral internal sphincterotomy show little difference between the two procedures both in fissure persistence and risk of incontinence. REVIEWER'S CONCLUSIONS: Anal stretch and posterior midline internal sphincterotomy should probably be abandoned in the treatment of chronic anal fissure in adults. For those patients requiring surgery for anal fissure, open and closed partial lateral internal sphincterotomy appear to be equally efficacious. More data are needed to assess the effectiveness of posterior internal sphincterotomy.

Anal Canal↗
PubMed2004

Treatment of fissure in ano- revisited.

INTRODUCTION: Fissure in ano is a troubling and painful condition that affects a great majority of the population world over. The nature and anatomy of fissure in ano is quite clear, and much is known about the various predisposing and contributing factors that lead to initiation and progression of the disease. The preferred method of treating them, one that results in optimal clinical results and the least pain and inconvenience to the patient, however, has been open to debate. METHODS: This paper outlines a brief account of the present scenario of different techniques available for the treatment of chronic anal fissure. CONCLUSION: Medical manipulation of the internal sphincter should be a first-line treatment in anal fissure. When this fails or fissures recur, lateral subcutaneous internal sphincterotomy should be the preferred options for the treatment of chronic fissure in ano. Nevertheless, all the option should be presented to the patient with complete information about the method, cure rates, complications, and recurrence of the disease.

Administration, Topical↗
PubMedDate not supplied

Current treatment options for fissure-in-ano.

BACKGROUND: Fissure-in-ano is a painful condition that affects a sizable majority of the population. Selecting a method of treating the condition that could achieve optimal clinical results and the least pain and inconvenience to the patient has always posed a challenge to the surgeons. This led to the innovation of a number of surgical and pharmacological methods that relax the anal muscle. While acute fissures could be managed with medical therapy alone, chronic fissures do need some form of manipulation to relieve internal sphincter spasm. MATERIALS AND METHODS: The present study discusses various techniques advocated for the treatment of acute and chronic fissure-in-ano. It also elaborates on the advantages and deficiencies of each. DISCUSSION: Despite the initial success with pharmacological agents in the treatment of patients with chronic anal fissures, a growing concern is developing about their use. Increasing incidence of adverse effects and decreasing long-term efficacy have been the major drawbacks. CONCLUSION: Surgery still remains the preferred option which should be offered to patients with relapse or therapeutic failure with prior pharmacological treatment. Nevertheless, the patient should be informed about the pros and cons of each mode of treatment with details of cure rates and possible complications.

Acute Disease↗
PubMed2005

Randomized prospective controlled trial of lateral internal sphincterotomy versus injection of botulinum toxin for the treatment of idiopathic fissure in ano.

BACKGROUND: Chronic anal fissure is a significant cause of morbidity. Internal sphincterotomy has long been the operative treatment of choice. Concerns remain, however, on its effects on continence. Botulinum toxin has been used as an agent for chemical sphincterotomy, causing temporary alleviation of sphincter spasm and allowing the fissure to heal. The aim of the present study was to compare the results of sphincterotomy to botulinum toxin. METHODS: The study was designed as a randomized controlled trial. All adult patients over the age of 18 with chronic idiopathic fissure in ano who had failed conservative treatment were included in the trial. Patients were randomized to receive either Botox or sphincterotomy. Pain, healing of fissure and continence scores were the outcomes assessed. RESULTS: A total of 38 patients were studied. Seventeen patients were randomized to receive Botox and 21, sphincterotomy. Patients in the Botox group were found to have significantly higher 2-week pain scores and reoperation rates, and poor healing. Continence scores were not significantly different in the two groups. CONCLUSION: Sphincterotomy gives better results than Botox in the treatment of fissure. Botox, however, is safe with no complications and no detriment to continence and could be used in certain situations.

Adult↗
PubMed2003

Sphincterotomy with radio frequency surgery: a new treatment technique of fissure in ano and associated pathologies.

BACKGROUND: Anal fissures are dealt with using traditional approaches aiming at relieving the anal spasm and minimizing the anal sphincter pressure. Nevertheless, pathologies like sentinel tags, anal papillae, anal polyps, or small hemorrhoids which are often associated with chronic fissures are either considered innocuous, therefore left untreated, or are removed by conventional techniques. MATERIAL AND METHODS: In this retrospective, non-randomized study, we performed lateral internal sphincterotomy, which was followed by radio frequency surgical procedures to eliminate the associated pathologies mentioned above. RESULTS: In all, 283 patients were studied. All the patients treated by the method of lateral subcutaneous internal sphincterotomy followed by radio frequency surgical procedure for aforesaid associated pathologies were made comfortable on account of the reduction in pain and irritation during defecation, the pricking or foreign body sensation in the anus and pruritus or wetness around the anal verge. A follow up after 18 months showed that only 7 % of patients had recurrence of symptoms or local signs. CONCLUSION: This combined approach has been found to be an effective, easy and quick way of treating chronic fissure in ano with associated pathologies

Anal Canal↗
PubMed1984

Outpatient treatment of fissure-in-ano.

A review of 86 cases of fissure-in-ano as seen in Ife is presented. The method of management is described and compared with other conservative methods of treatment. The results show a complete healing of the condition within two weeks as compared with four to six weeks recorded in other series. Healing was confirmed by a complete resolution of symptoms together with re-epithelisation of the fissure on inspection at proctoscopy. It is suggested that the described surgical management is simple, fast, cost reducing and time saving in the treatment of fissure-in-ano. It is further envisaged that this procedure may also serve as a means of relief to our already congested hospitals.

Adolescent↗
PubMed1975

Fissure-in-ano and anal stenosis. Part I: conservative management.

Acute superficial fissure-in-ano responds readily to conservative non-surgical treatment. For chronic deep fissures we recommend manual anal dilatation and the post-dilatation regimen but recognise that equally good results follow the simple procedure of subcutaneous lateral internal sphincterotomy. The recurrence rate following these minor procedures is less than 10 per cent and the incidence of poor flatus control and mucus leakage is even lower. It is never necessary to excise fissures nor sentinel piles although it may be desirable to excise large redundant skin tags to facilitate anal hygiene. Painless or atypically sited fissures should suggest the diagnosis of Crohn's disease. Treatment is rarely required for fissure-in-ano in this condition, although severe anal stenosis may need extremely gentle anal dilatation. Postoperative anal stenosis can also be managed successfully by manual dilatation under anaesthesia with a prolonged regimen of self dilatation until healing is complete. Radical or complicated plastic operations are rarely indicated for any patient with fissure-in-ano or stenosis and are strongly contraindicated in Crohn's disease.

Acute Disease↗
PubMed2005

Operative procedures for fissure in ano.

BACKGROUND: Operative techniques commonly used for fissure in ano include: anal stretch, open lateral sphincterotomy, closed lateral sphincterotomy, posterior midline sphincterotomy and to a lesser extent dermal flap coverage of the fissure. Reports of direct comparisons between operative techniques for anal fissure are variable in their results. These reports are either subject to selection bias (in non-randomized studies) or observer bias (in all studies) or have inadequate numbers of patients enrolled to answer the question of efficacy. OBJECTIVES: To determine the best technique for fissure surgery. SEARCH STRATEGY: The Cochrane Central Register of Controlled Trials and MEDLINE (1965-2005) were searched. The list of cited references in all included reports and several study authors also were helpful in finding additional comparative studies. SELECTION CRITERIA: All reports in which there was a direct comparison between at least two operative techniques were reviewed and when more than one report existed for any given pair, that report was included. If crude data were not presented in the report, the authors were contacted and crude data obtained. DATA COLLECTION AND ANALYSIS: The two most commonly used end points in all reported studies were persistence of the fissure and post operative incontinence of flatus. These are the only two endpoints included in the meta-analysis. MAIN RESULTS: Twenty-four trials encompassing 3475 patients are included in this review . Anal stretch has a higher risk of fissure persistence than internal sphincterotomy and also a significantly higher risk of minor incontinence than sphincterotomy. The combined results of open versus closed partial lateral internal sphincterotomy show little difference between the two procedures both in fissure persistence and risk of incontinence. AUTHORS' CONCLUSIONS: Anal stretch and posterior midline internal sphincterotomy should probably be abandoned in the treatment of chronic anal fissure in adults. For those patients requiring surgery for anal fissure, open and closed partial lateral internal sphincterotomy appear to be equally efficacious. More data are needed to assess the effectiveness of posterior internal sphincterotomy, anterior levatorplasty, wound suture or papilla excision.

Anal Canal↗
PubMed1997

Re-examination of clinical manifestations and response to therapy of fissure-in-ano.

PURPOSE: This study was designed to reassess clinical manifestations of fissure-in-ano, in particular, the frequency of constipation and rate of response to medical management. METHODS: Records of 876 patients with fissure-in-ano seen between February 1975 and December 1993 were reviewed. Information gathered included age, gender, site, symptoms, bowel habits, associated anorectal problems, response, failure, and recurrence rates. RESULTS: There were 439 women (51.1 percent) and 437 men (49.9 percent); mean age was 39.9 (range, 13.5-95) years. The fissure was located in the posterior mid line in 644 patients (73.5 percent), the anterior mid line in 144 patients (16.4 percent), both in 23 patients (2.6 percent), and only tenderness documented in 65 patients (7.4 percent). The fissure was located in the anterior midline in 12.6 percent of women and 7.7 percent of men. Dominant presenting symptoms included pain in 90.8 percent and bleeding in 71.4 percent of patients. Infrequent hard bowel movements (> or = 3 days) occurred in only 13.8 percent of patients. Mean follow-up was 26 (range, 0.5-215) months. A total of 44.7 percent of patients responded to nonoperative therapy, 60 percent of them in the first two months; of these, 18.6 percent developed recurrent symptoms. Of the latter group, 60 percent responded to further medical therapy, and 20 percent underwent a lateral internal sphincterotomy. Of the patients who initially did not respond to medical treatment (50.5 percent), lateral internal sphincterotomy was recommended. CONCLUSION: Anterior fissures are much more common in both men and women than previously reported, and constipation and hard bowel movement are not universally present in patients with fissure-in-ano.

Adult↗
PubMed2002

Fissurectomy and isosorbide dinitrate for chronic fissure in ano not responding to conservative treatment.

BACKGROUND: Although lateral sphincterotomy heals chronic fissure in ano in over 90 per cent of cases it is a surgical technique with inherent complications. To avoid such complications, chronic fissure in ano was treated by fissurectomy in this study. To enhance postoperative tissue perfusion allowing stable wound healing, fissurectomy was combined with temporary chemical sphincterotomy by a nitric oxide donor cream. METHODS: Seventeen consecutive patients (ten women) with chronic fissure in ano not responding to conservative management underwent diathermy fissurectomy. After operation patients used a 1 per cent isosorbide dinitrate cream. Postoperative follow-up continued until wounds had healed, at which time anal endosonography was performed. A telephone inquiry into fissure recurrence and continence status was made. RESULTS: Seventeen patients underwent fissurectomy, without postoperative complications. All wounds had healed within 10 weeks. No fissure recurrence was seen after a median follow-up of 29 months. Histopathology showed non-specific scar tissue without signs of internal anal sphincter fibrosis. Postoperative endosonography showed no evidence of new internal sphincter defects. CONCLUSION: In the treatment of chronic anal fissure not responding to chemical sphincterotomy with nitric oxide donors, fissurectomy in combination with isosorbide dinitrate cream may be a sphincter-sparing surgical technique.

Adult↗
PubMed1999

Meta-analysis of operative techniques for fissure-in-ano.

PURPOSE: Operative techniques commonly used for fissure-in-ano include anal stretch, open lateral sphincterotomy, closed lateral sphincterotomy, posterior midline sphincterotomy, and to a lesser extent dermal flap coverage of the fissure. Reports of direct comparisons among these techniques are variable in their results and for the most part underpowered. A rigorous analysis of the combined reports was therefore undertaken to determine whether a preferred technique for fissure surgery can be elucidated. METHODS: MEDLINE was searched for all published reports using the key words "surgery" and "anal fissure." All reports in which there was a direct comparison between at least two operative techniques were reviewed, and when more than one report existed for any given pair, that report was included in the meta-analysis. If crude data were not presented in the report, the authors were contacted, and crude data were obtained. The two most commonly used end points in these reports were persistence of the fissure and postoperative incontinence of flatus. These are the only two end points included in the meta-analysis. The meta-analysis was performed using Epi-Info software obtained from the Centers for Disease Control and Prevention (www.cdc.gov). RESULTS: Seventeen publications fulfilled the criteria of the study, encompassing 2,727 patients. Significant differences were found for both persistence and incontinence to flatus when comparing anal stretch to all forms of sphincterotomy. No significant difference was found comparing open to closed lateral internal sphincterotomy for persistence or incontinence. Posterior midline sphincterotomy was not significantly different from lateral sphincterotomy related to persistence or incontinence. CONCLUSION: Internal anal sphincterotomy is superior to anal stretch and should probably be performed in the lateral location, although both the open and closed techniques seem equally efficacious.

Databases, Factual↗
PubMed1965

FISSURE IN ANO.

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Fissure in Ano↗
PubMed1977

Fissure-in-ano.

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Fissure in Ano↗
PubMed2002

Current trends of management for fissure in ano.

There are many options to treat chronic fissures in ano. Some of them are non-surgical while the others are surgical. The efficacy claimed by each of the prevalent method is very high but the inconsistencies and contraindications are equally strong. To date, lateral sphincterotomy has been favoured by most of the proctologists, because it is the least extensive surgical procedure and is offering a long lasting relief in sphincter spasm. About 10 different techniques are presented in brief with their efficacy and fallacy. A new method combining the age-old technique of Lord's manual dilatation followed by radio surgery is also highlighted. The addition of radio surgery is found useful for refreshing the edges of the fissure and to tackle pathologies namely sentinel pile, small internal piles or hypertrophied anal papillae often found associated with chronic fissures. Revisiting the trends of treatment of chronic anal fissures, the most preferred options are the manual dilatation with radio surgery and the subcutaneous lateral anal sphincterotomy. Both methods are easy to perform, have negligible complications and no special setup is needed, except the radio surgical unit, in case of the first procedure. However, all the options should be presented to the patient with complete information about the method, cure rates, complications, and reversibility of the complications and the final choice should be left in his hands.

Anal Canal↗
PubMed1988

Diet and other risk factors for fissure-in-ano. Prospective case control study.

The findings of a partly prospective case control study of chronic fissure-in-ano conducted in two Danish outpatient clinics are reported. One hundred seventy-four patients with chronic fissure-in-ano were matched by age and sex to outpatients from the same community suffering from benign skin tumors. All subjects were interviewed regarding diet, beverage consumption, occupational exposures, and medical and surgical history. Significantly decreased risks were associated with frequent consumption of raw fruits, vegetables, and whole-grain bread, and significantly increased risks were associated with frequent consumption of white bread, sauces thickened with roux, and bacon or sausages. Risk ratios for consumption of coffee, tea, and alcohol were not significantly different. No statistical associations were found with particular occupational exposures. However, a history of previous anal surgery was reported significantly more often for cases than for controls. Current evidence indicates that anal fissure is likely to result at least partly from an inappropriate diet and that dietary manipulations might reduce the incidence of fissure-in-ano.

Adult↗