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La Revue Du Praticien Nov 2019Anal fissure. Anal fissure is a painful proctological disease that most often affects young patients equally in both sexes. It significantly worsens the quality of life...
Anal fissure. Anal fissure is a painful proctological disease that most often affects young patients equally in both sexes. It significantly worsens the quality of life and requires rapid care. The anal fissure is most often located in the posterior anal commissure and frequently surmounted by a skin tag which can hide it and wrongly carry the diagnosis of hemorrhoids. Differential diagnoses such as carcinoma, Crohn's disease, sexually transmitted infection, etc. should be mentioned in case of atypical presentation. Its pathophysiology remains controversial, but in most cases, it results from the trauma of the passage of hard stools on an hypertonic anus. Medical treatment can cure just over half of patients. Surgery is reserved for failures of medical treatment and hyperalgesic fissure. In France, fissurectomy is the most commonly performed procedure while on the other side of the Channel or the Atlantic, lateral internal sphincterotomy is considered as the reference technique.
Topics: Anal Canal; Chronic Disease; Female; Fissure in Ano; France; Hemorrhoids; Humans; Male; Quality of Life; Treatment Outcome
PubMed: 32237626
DOI: No ID Found -
The British Journal of Surgery Mar 2004The treatment of chronic anal fissure has shifted in recent years from surgical to medical. (Review)
Review
BACKGROUND
The treatment of chronic anal fissure has shifted in recent years from surgical to medical.
METHODS
A Medline search of studies relevant to modern management of chronic anal fissure was undertaken.
RESULTS
Traditional surgery that permanently weakens the internal sphincter is associated with a risk of incontinence. Medical therapies temporarily relax the internal sphincter and pose no such danger, but their limited efficacy has led to displacement rather than replacement of traditional surgery. Emerging medical therapies promise continued improvement and new sphincter-sparing surgery may render traditional surgery redundant.
CONCLUSION
First-line use of medical therapy cures most chronic anal fissures cheaply and conveniently. The few non-responders can be targeted for sphincter assessment before traditional surgery. If the initial good results of new sphincter-sparing surgery are confirmed, it may be possible to avoid any risk of incontinence, while achieving high rates of fissure healing.
Topics: Anal Canal; Botulinum Toxins, Type A; Calcium Channel Blockers; Diltiazem; Fecal Incontinence; Fissure in Ano; Humans; Nitric Oxide Donors; Nitroglycerin; Postoperative Complications; Retreatment; Treatment Failure
PubMed: 14991625
DOI: 10.1002/bjs.4531 -
Diseases of the Colon and Rectum Mar 2018
Topics: Adult; Anal Canal; Disease Management; Female; Fissure in Ano; Humans
PubMed: 29420424
DOI: 10.1097/DCR.0000000000001042 -
Journal of Visceral Surgery Apr 2015Anal fissure is an ulceration of the anoderm in the anal canal. Its pathogenesis is due to multiple factors: mechanical trauma, sphincter spasm, and ischemia. Treatment... (Review)
Review
Anal fissure is an ulceration of the anoderm in the anal canal. Its pathogenesis is due to multiple factors: mechanical trauma, sphincter spasm, and ischemia. Treatment must address these causative factors. While American and British scientific societies have published recommendations, there is no formal treatment consensus in France. Medical treatment is non-specific, aimed at softening the stool and facilitating regular bowel movements; this results in healing of almost 50% of acute anal fissures. The risk of recurrent fissure remains high if the causative factors persist. If non-specific medical treatment fails, specific medical treatment can be offered to reversibly decrease hypertonic sphincter spasm. Surgery remains the most effective long-term treatment and should be offered for cases of chronic or complicated anal fissure but also for acute anal fissure with severe pain or for recurrent fissure despite optimal medical treatment. Surgical treatment is based on two principles that may be combined: decreasing sphincter tone and excision of the anal fissure. Lateral internal sphincterotomy (LIS) is the best-evaluated technique and remains the gold standard in English-speaking countries. Since LIS is associated with some risk of irreversible anal incontinence, its use is controversial in France where fissurectomy combined with anoplasty is preferred. Other techniques have been described to reduce the risk of incontinence (calibrated sphincterotomy, sphincteroplasty). The technique of forcible uncalibrated anal dilatation is no longer recommended.
Topics: Anal Canal; Digestive System Surgical Procedures; Dilatation; Evidence-Based Medicine; Fecal Incontinence; Fissure in Ano; Humans; Randomized Controlled Trials as Topic; Treatment Outcome; Wound Healing
PubMed: 25305752
DOI: 10.1016/j.jviscsurg.2014.07.007 -
Gastroenterologie Clinique Et Biologique Nov 2007
Review
Topics: Anal Canal; Digestive System Surgical Procedures; Fecal Incontinence; Fissure in Ano; Humans
PubMed: 18166891
DOI: 10.1016/s0399-8320(07)78311-2 -
British Journal of Hospital Medicine... Aug 2008Patients often present to general and colorectal clinics with symptoms of anal fissures and can even present acutely to hospital. Conservative remedies have healing... (Review)
Review
Patients often present to general and colorectal clinics with symptoms of anal fissures and can even present acutely to hospital. Conservative remedies have healing rates of up to 85% and have largely replaced surgery as first-line management. This review highlights the cardinal points in the aetiology, pathogenesis and treatment of anal fissures.
Topics: Anal Canal; Botulinum Toxins; Calcium Channel Blockers; Dilatation; Fissure in Ano; Humans; Isosorbide Dinitrate; Nitroglycerin; Surgical Flaps
PubMed: 18783093
DOI: 10.12968/hmed.2008.69.8.30742 -
International Journal of Surgery... Jun 2022Anal fissure is a linear tear in the distal anoderm most frequently occurring in the posterior midline. Lateral internal sphincterotomy is considered the gold standard... (Review)
Review
BACKGROUND
Anal fissure is a linear tear in the distal anoderm most frequently occurring in the posterior midline. Lateral internal sphincterotomy is considered the gold standard for the treatment of this condition. To this date, several pharmacological and neuromodulatory therapies have been tried out as alternative non-invasive treatments for anal fissures, however, the efficacy of some of these methods remains to be understood.
OBJECTIVE
the primary aim of this study was to review available literature on neuromodulatory treatments for recurrent anal fissure as a potentially effective cure for this condition.
DATA SOURCES
A search was conducted among five main online databases Embase, PubMed, Web of Science, Scopus, and Scholar.
STUDY SELECTION
All published human studies in English literature addressing neuromodulation for the treatment of recurrent anal fissure were selected.
INTERVENTION
neuromodulation for the treatment of anal fissure. We chose to include all articles in which the authors stated that the procedure they performed was via neuromodulation technique, or that the described technique used in their study resembled the technique.
RESULT
Among a total of 3487 evaluated studies, seven represented the effects of neuro modulation on treatment of recurrent anal fissure, among which two were randomized controlled trials and the rest were prospective studies. A total of 186 patient were evaluated in these studies. The mean age of the participants was 46.97 ± 8.2. The average VAS score before intervention was 7.77 ± 2.13, which decreased to 0.31 ± 1.13 after intervention.
LIMITATIONS
limitations of this study include the lack of related articles, and data regarding this subject.
CONCLUSION
Posterior tibial nerve stimulation (PTNS) provides rapid pain relief and fissure healing especially in short-to mid-terms with little to no complications, however, using this treatment, symptoms of anal fissure do not improve as well as LIS, especially in the long-term.
Topics: Anal Canal; Chronic Disease; Fecal Incontinence; Fissure in Ano; Humans; Prospective Studies; Treatment Outcome
PubMed: 35568308
DOI: 10.1016/j.ijsu.2022.106661 -
Scandinavian Journal of... 1996The posterior commissure of the anal canal is less well perfused than the other segments of the anoderm. There is growing evidence that the increased activity of the... (Review)
Review
The posterior commissure of the anal canal is less well perfused than the other segments of the anoderm. There is growing evidence that the increased activity of the internal anal sphincter, which is found in almost all patients with a chronic anal fissure, further decreases the anodermal blood supply, especially at the posterior midline. Reduction of anal pressure, either by anal dilatation or by lateral internal sphincterotomy, is the most important step in the treatment of chronic anal fissure. However, both procedures frequently result in permanent sphincter defects and subsequent continence disturbances. Recently, nitric oxide (NO) has been identified as the chemical messenger mediating relaxation of the internal anal sphincter. It has been shown that local application of exogenous NO donors such as nitroglycerin and isosorbide-di-nitrate reduces anal pressure and improves anodermal blood flow. This dual effect results in fissure healing in more than 80% of patients.
Topics: Anal Canal; Clinical Trials as Topic; Fissure in Ano; Humans; Prognosis
PubMed: 8865454
DOI: 10.3109/00365529609094734 -
Techniques in Coloproctology Jul 2020
Topics: Anal Canal; Chronic Disease; Fissure in Ano; Humans; Rectal Fistula
PubMed: 32476079
DOI: 10.1007/s10151-020-02253-2 -
La Revue Du Praticien Mar 2023MANAGEMENT OF ANAL FISSURE. The news in the management of the anal fissure are few but to know. The medical treatment must be well explained to the patient and optimized...
MANAGEMENT OF ANAL FISSURE. The news in the management of the anal fissure are few but to know. The medical treatment must be well explained to the patient and optimized from the outset. Healthy bowel movements combining a sufficient fiber intake and soft laxatives must be continued for at least 6 months. Pain control is important. Topicals, specific (in case of sphincter hypertonia) or not, must be maintained for 6 to 8 weeks. Calcium channel blockers seem the most interesting with fewer side effects for similar effectiveness. Surgery is proposed (apart a no medically control of the pain or a fistula associated) in the event of failure of well-conducted medical treatment. It remains the most effective long-term treatment. Lateral internal sphincterotomy has its place in the absence of anal continence disorder, in which case fissurectomy and/or cutaneous anoplasty can be proposed.
Topics: Humans; Fissure in Ano; Treatment Outcome; Defecation; Digestive System Surgical Procedures; Pain; Chronic Disease
PubMed: 37289116
DOI: No ID Found