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Diseases of the Colon and Rectum Aug 2021
Topics: Chronic Disease; Fissure in Ano; Humans; Lateral Internal Sphincterotomy
PubMed: 34214059
DOI: 10.1097/DCR.0000000000002125 -
JAMA Feb 2021
Topics: Anal Canal; Fissure in Ano; Humans; Lateral Internal Sphincterotomy; Postoperative Complications
PubMed: 33591347
DOI: 10.1001/jama.2020.16708 -
Surgery Jul 2022There are multiple treatments for anal fissures. These range from medical treatment to surgical procedures, such as sphincterotomy. The aim of this study was to compare... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
There are multiple treatments for anal fissures. These range from medical treatment to surgical procedures, such as sphincterotomy. The aim of this study was to compare the relative clinical outcomes and effectiveness of interventional treatments for anal fissure.
METHODS
Randomized controlled trials were identified by means of a PRISMA-compliant systematic review using the Medline, EMBASE, and CENTRAL databases. Inclusion criteria were randomized controlled trials comparing treatments for anal fissure. A Bayesian network meta-analysis was performed using BUGSnet package in R. Outcomes of interest were healing (6-8-, 10-16-, and >16-week follow-up), symptom recurrence, pain (measured on a visual analog scale), and fecal or flatus incontinence. PROPSERO Registration: CRD42021229615.
RESULTS
Sixty-nine randomized controlled trials were included in the analysis. Lateral sphincterotomy remains the treatment with the highest odds of healing compared to botulinum toxin and medical therapy at all follow-up time points. There was no significant difference in healing between botulinum toxin and medical therapy at any time point. Advancement flap showed similar effectiveness compared to lateral sphincterotomy. Medical treatment and botulinum toxin had the highest pain scores at follow-up. Sphincterotomy had the highest odds of fecal and flatus incontinence.
CONCLUSION
Lateral sphincterotomy had the highest rates of healing and should be considered as the definitive treatment after failed initial therapy with botulinum toxin or medical treatment. Botulinum toxin was equally effective compared to medical treatment. Advancement flap shows similar effectiveness compared to lateral sphincterotomy, but more studies are needed to evaluate its efficacy.
Topics: Anal Canal; Bayes Theorem; Botulinum Toxins; Chronic Disease; Fissure in Ano; Flatulence; Humans; Network Meta-Analysis; Pain; Treatment Outcome
PubMed: 34998619
DOI: 10.1016/j.surg.2021.11.030 -
Frontiers in Public Health 2022Anal fissure is a common colorectal disease impacting patients' life quality with high incidence. Social media platforms are becoming a kind of health information source...
INTRODUCTION
Anal fissure is a common colorectal disease impacting patients' life quality with high incidence. Social media platforms are becoming a kind of health information source nowadays. This study aims to evaluate and compare the quality of anal fissure-related videos on TikTok and YouTube.
MATERIALS AND METHODS
One hundred videos were sourced from TikTok and YouTube, respectively and videos were screened further. The completeness of six types of content within the videos is assessed, including the definition of disease, symptoms, risk factors, evaluation, management and outcomes. Finally, the DISCERN instrument, Patient Education Materials Assessment Tool and Global Quality scale are used to assess video display quality and content. A correlation analysis is undertaken considering the video features, DISCERN, PEMAT and GQS scores.
RESULTS
Physicians and non-profit organizations contributed almost all video content among selected videos. A statistically significant correlation between DISCERN classification and duration, PEMAT understandability, PEMAT actionability and GQS scores is recorded. DISCERN total scores were significantly positively correlated with video duration, PEMAT understandability, PEMAT actionability and GQS scores. GQS scores were significantly positively correlated with duration, PEMAT understandability and PEMAT actionability scores. For content, the videos mainly described management and symptoms while containing limited information on the disease evaluation, and outcomes.
CONCLUSIONS
The sources of uploaders on YouTube are more diverse than TikTok, and the quality of videos is also relatively higher on YouTube. Even so, the video quality of the two platforms still needs to be further improved. Health information without integrity, reliability and practicability impacts patients' disease perception and health-seeking behavior, leading to serious consequences. Much effort must be taken to improve the quality of videos regarding anal fissures on the two platforms, which will facilitate the development of public health education on this issue.
Topics: Humans; Social Media; Video Recording; Reproducibility of Results; Fissure in Ano
PubMed: 36407987
DOI: 10.3389/fpubh.2022.1000338 -
Diseases of the Colon and Rectum Jan 2023A 48-year-old healthy man presented to the office reporting a long-standing history of anal pruritus. He had tried various over-the-counter creams without much success....
A 48-year-old healthy man presented to the office reporting a long-standing history of anal pruritus. He had tried various over-the-counter creams without much success. Besides an anal fissure in the past, which responded to nitroglycerin ointment, his medical history was unremarkable. On physical examination, he was found to have grade I hemorrhoids and mild fecal smearing on perianal skin. Recent colonoscopy and laboratory work ordered by the primary care provider were normal. He was counseled on common inciting agents and local irritants and was advised on hygiene, diet modification, and stool-bulking agents. The colorectal surgeon recommended that the patient keep a journal about his symptoms, foods, and household chemicals used. He was seen twice more over the course of 6 months to pinpoint the cause of his pruritus. A short-course trial of topical steroid, barrier cream, and topical tacrolimus was not helpful. A biopsy of perianal skin was performed and was unrevealing. Eventually, given the persistence of symptoms, it was decided that he would undergo methylene blue injection to address his pruritus (Fig. 1). The procedure consisted of several intradermal and subcutaneous injections of 10 mL of 1% methylene blue combined with 7.5 mL of 0.25% bupivacaine with adrenaline (1/100,000) and 7.5 mL 0.5% lidocaine. After the methylene blue injection, the severity of his symptoms improved, but pruritus still persisted. A methylene blue injection of the same concentration was repeated in 3 months with complete resolution of symptoms.
Topics: Male; Humans; Middle Aged; Pruritus Ani; Methylene Blue; Fissure in Ano; Nitroglycerin; Hemorrhoids
PubMed: 36515511
DOI: 10.1097/DCR.0000000000002661 -
Clinics in Colon and Rectal Surgery Jul 2019Perianal symptoms occur in up to 50% of patients with Crohn's disease in other parts of the gastrointestinal tract, and in 5% of patients it is the first manifestation... (Review)
Review
Perianal symptoms occur in up to 50% of patients with Crohn's disease in other parts of the gastrointestinal tract, and in 5% of patients it is the first manifestation of the disease. The perianal area is often under stress in patients with Crohn's disease, because of the diarrhea, and the fecal urgency, frequency, and incontinence caused by proximal disease. Symptomatic perianal disease can therefore be due to the effects of the stress on an otherwise normal anus, or the result of Crohn's disease in the low rectum and/or perianal tissues themselves. This key distinction should drive the investigation and management of anal and perianal symptoms in patients with Crohn's disease. In this review, the evaluation and management of the various manifestations of Crohn's disease in the perineum and perianal tissues will be described.
PubMed: 31275071
DOI: 10.1055/s-0039-1683907 -
Cureus Oct 2022The anal fissure is frequently seen in surgical practice. It is caused by a longitudinal tear in the anoderm distal to the dentate line. The hallmark feature of the...
BACKGROUND
The anal fissure is frequently seen in surgical practice. It is caused by a longitudinal tear in the anoderm distal to the dentate line. The hallmark feature of the disease is severe pain during defecation. Chronic anal fissure (CAF) causes undue stress that leads to poor quality of life. Different options of treatment, whether medical or surgical, are employed to treat this condition. One of these modalities is lateral internal anal sphincterotomy (LIAS).
OBJECTIVES
We aimed to assess the safety and efficacy of the LIAS surgical procedure for the treatment of CAF.
MATERIALS AND METHODS
This retrospective study was conducted at the Al-Muqdadiya General Hospital, Diala, Iraq, for a period from January 2016 to March 2021. The medical records of the patients with CAF who were subjected to LIAS under local anesthesia were reviewed. Data regarding the age, gender, smoking habit, body mass index (BMI), healing time, complications, and outcome for each participant were recorded.
RESULTS
Of 165 participants, there were 91 men. The majority of the cases were ≤ 35 years (78.19%), were non-smokers (80%), and had no history of DM (98.79%). There was complete healing with a resolution of the pain at two months postoperatively in 163 subjects. The most common complication in our study was flatus incontinence (n = 5). All of them were found in the age group > 35 years and women. There were statistically significant differences between the age groups, gender, BMI, and the occurrence of flatus incontinence (P-value = 0.000, 0.012, and 0.009 respectively). However, there was no such association between smoking habit and a history of DM (P-value > 0.05). Conclusion: LIAS is safe and effective in the treatment of CAF, with an excellent outcome in resolving pain and a low complication rate. Age, female gender, and high BMI might affect the occurrence of flatus incontinence.
PubMed: 36415415
DOI: 10.7759/cureus.30530 -
Wound Repair and Regeneration :... 2023Anal fissure is one of the most prevalent diagnosis in patients with anorectal symptoms. Depending on the chronicity, treatment choices vary, from topical and... (Randomized Controlled Trial)
Randomized Controlled Trial
Anal fissure is one of the most prevalent diagnosis in patients with anorectal symptoms. Depending on the chronicity, treatment choices vary, from topical and conservative management to operative ones. PRP is a blood-derived product with a three to five-fold platelet count and can be used for restorative purposes. The objective of this study is to assess the therapeutic effect of intralesional PRP in acute and chronic anal fissures and comparing it with the classic topical approach. We included 94 patients with acute and chronic anal fissures and divided them into intervention and control groups. Control patients were treated only with topical compounds, and the intervention group received one dose of intralesional autologous PRP plus the same classic treatment. We assessed patients 2 weeks, 1 month, and 6 months later. The mean pain score in the intervention group was significantly lower than control groups in all visits (p-value <0.001). During the follow-ups, the bleeding rate was significantly lower in the intervention group, so in the sixth month, the bleeding was 4% in the intervention group against 32% of the control (p-value <0.001). The healing rate assessed by examination was 96% in the intervention group against 66% in the control in the sixth month (p-value <0.001). Although there may be no significant difference in healing rate between groups in the acute anal fissure, the PRP group is significantly superior in the chronic setting. We concluded that in anal fissure treatment, PRP plus topical products are significantly superior to alone topical treatment.
Topics: Humans; Administration, Topical; Chronic Disease; Fissure in Ano; Platelet-Rich Plasma; Treatment Outcome; Wound Healing
PubMed: 37340514
DOI: 10.1111/wrr.13103 -
Handbook of Experimental Pharmacology 2021Botulinum toxin (BT), one of the most powerful inhibitors that prevents the release of acetylcholine from nerve endings, represents an alternative therapeutic approach... (Randomized Controlled Trial)
Randomized Controlled Trial
Botulinum toxin (BT), one of the most powerful inhibitors that prevents the release of acetylcholine from nerve endings, represents an alternative therapeutic approach for "spastic" disorders of the gastrointestinal tract such as achalasia, gastroparesis, sphincter of Oddi dysfunction, chronic anal fissures, and pelvic floor dyssynergia.BT has proven to be safe and this allows it to be a valid alternative in patients at high risk of invasive procedures but long-term efficacy in many disorders has not been observed, primarily due to its relatively short duration of action. Administration of BT has a low rate of adverse reactions and complications. However, not all patients respond to BT therapy, and large randomized controlled trials are lacking for many conditions commonly treated with BT.The local injection of BT in some conditions becomes a useful tool to decide to switch to more invasive therapies. Since 1980, the toxin has rapidly transformed from lethal poison to a safe therapeutic agent, with a significant impact on the quality of life.
Topics: Botulinum Toxins; Esophageal Achalasia; Fissure in Ano; Humans; Quality of Life; Treatment Outcome
PubMed: 32072269
DOI: 10.1007/164_2019_326 -
Current Opinion in Gastroenterology Jan 2022There continues to be a concentrated effort to improve treatment options readily available for some of the most common perianal diseases: hemorrhoids, anal fissure and... (Review)
Review
PURPOSE OF REVIEW
There continues to be a concentrated effort to improve treatment options readily available for some of the most common perianal diseases: hemorrhoids, anal fissure and anal fistula. The emphasis remains on therapies that definitively address the underlying pathology yet minimize pain and risk of incontinence, have a short recovery period, and are cost-effective. In this analysis, recent developments in the literature are reviewed.
RECENT FINDINGS
Treatment of early stage hemorrhoidal disease remains the same. For grades II-IV disease, hemorrhoidal vessel ligation/obliteration with laser or bipolar energy are reported. For more advanced diseases, modifying the technique for hemorrhoidectomy to improve postoperative complications and pain is described. For anal fissure, a stepwise method continues to be the mainstay of treatment (initiating with vasodilators, followed by botox, and ultimately sphincterotomy), which decreases the risk of incontinence with proper patient selection and technique. Management of anal fistula continues to be challenging, balancing cure vs. risk of harm. Recent developments include modifications to ligation of intersphincteric fistula tract procedure and use of laser to obliterate the tract.
SUMMARY
Advancements in managing benign anorectal disease are ongoing. Several reports are novel, whereas others involve enhancing well-established treatment options by either operative technique or patient selection.
Topics: Hemorrhoidectomy; Hemorrhoids; Humans; Ligation; Postoperative Complications; Treatment Outcome
PubMed: 34636364
DOI: 10.1097/MOG.0000000000000795