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Revue Medicale Suisse Jun 2024Anal pain can be acute (most commonly related to anal fissure, perianal abcess or fistula, perianal vein thrombosis) or chronic (functional or neuropathic) including...
Anal pain can be acute (most commonly related to anal fissure, perianal abcess or fistula, perianal vein thrombosis) or chronic (functional or neuropathic) including levator ani syndrome, proctalgia fugax, pudendal nevralgia and coccygodynia. History and clinical examination are keys to diagnose acute causes. Diagnosis of chronic anal pain on the other hand is more challenging and based on thorough history and analysis of symptoms. The aim of this article is to discuss the main etiologies and treatments of acute and chronic anal pain, including an update on the management and treatment of hemorrhoidal disease and postoperative pain management.
Topics: Humans; Chronic Pain; Acute Pain; Anus Diseases; Pain Management; Anal Canal
PubMed: 38867559
DOI: 10.53738/REVMED.2024.20.878.1151 -
Updates in Surgery May 2024To describe patients with anal fissure (AF) and their management in primary care. Retrospective study using the Italian Longitudinal Patient Database on 18 + years...
To describe patients with anal fissure (AF) and their management in primary care. Retrospective study using the Italian Longitudinal Patient Database on 18 + years old subjects with AF records during 'July 2016-June 2021' (selection period). Index Date (ID) was the first AF record during selection period. Sub-cohorts were defined by presence/absence of prescriptions on ID of the combination of topical nifedipine 0.3% and lidocaine 1.5% (NIF/LID). Patients' information on the 12-month period before (baseline) and after (follow-up) ID was analyzed. Subjects with AF were 8632: 14.0% had NIF/LID on ID. Mean age was 52 (± 17.2) years, there were more women in ' < 50 years' group, and more men in '50-70' one. Prevalences of pregnancy and immunodepression were around 5%; most common comorbidities were hypertension (29.6%) and heart disease (13.1%), while constipation and diarrhea were < 5%. Healthcare resources utilization (HRUs) increased during follow-up, but still few patients were prescribed NIF/LID (2.8%), other treatments for AF (10.3%), or proctological visits (7.7%). NIF/LID patients were younger (< 40 years people: 30.7% versus 23.9%; p value < 0.0001), and more likely to have constipation (4.3% versus 2.5%; p value < 0.001); patients without NIF/LID showed slightly higher prevalences of hypertension (30.0% versus 27.1%; p value: 0.039) and depression (4.0% versus**2.5%; p value: 0.009), and a little higher overall HRUs. Results show that general practitioners are used to manage AF. However, there is still a gap between guidelines' recommendations and actual management. Educational campaigns on common anal problems in primary care might help further improving AF management and optimizing HRUs.
PubMed: 38796820
DOI: 10.1007/s13304-024-01882-8 -
Diseases of the Colon and Rectum May 2024Fissure in ano is a prevalent and painful condition, typically treated by lateral internal sphincterotomy (LIS) after conservative measures fail. Dilip's transmucosal...
BACKGROUND
Fissure in ano is a prevalent and painful condition, typically treated by lateral internal sphincterotomy (LIS) after conservative measures fail. Dilip's transmucosal internal sphincterotomy (TMIS) introduces a simplified approach that reduces the risk of damaging the external sphincter, making it particularly suitable for less experienced surgeons. This innovation offers a less invasive method with minimal risk of incontinence, providing a safer, more accessible option.
IMPACT OF INNOVATION
TMIS simplifies the LIS process, offering a tailored approach that eliminates the need for extensive dissection. This method allows surgeons complete control over the internal sphincter bundle, facilitating a precise, customizable cut without the risks associated with traditional LIS, especially in obese patients where the intersphincteric groove is not visible, leading to potentially harmful blind incisions.
TECHNOLOGY MATERIALS AND METHODS
The procedure is performed under saddle block anesthesia with the patient in lithotomy position. A distinctive approach involving the use of retractors and stay sutures allows the internal sphincter to be made prominent and secured without extensive dissection. The division of the internal sphincter is achieved through a minimal mucosal incision, requiring no closure and significantly reducing postoperative pain and complications.
PRELIMINARY RESULTS
Between December 2020 and February 2022, 124 patients received TMIS, showing significant benefits with a median operative time of 7 minutes and low post-operative pain. With a 2.5% infection rate effectively managed and a 3% transient incontinence rate, the majority healed within 9 weeks. Recurrence was rare at 1.6%.
CONCLUSIONS AND FUTURE DIRECTIONS
TMIS presents significant advantages over traditional LIS, including reduced pain, lower risk of complications such as hematoma, abscess, or fistula formation, and the absence of painful postoperative nodules. TMIS's success suggests it should be incorporated into surgical education, offering a less daunting, more reproducible method for treating fissure-in-ano, especially beneficial for junior surgeons and improving patient outcomes.
PubMed: 38772018
DOI: 10.1097/DCR.0000000000003366 -
Revista Espanola de Enfermedades... May 2024Haemorrhoidal disease and anal fissure are the two most frequent entities within benign anal pathology, both of which have a negative impact on patients' quality of...
Haemorrhoidal disease and anal fissure are the two most frequent entities within benign anal pathology, both of which have a negative impact on patients' quality of life. To date, there is no specific questionnaire in Spanish to assess the impact on quality of life in patients suffering from these conditions. The aim of our study is to validate in Spanish a questionnaire for this purpose, adapting it to our daily clinical practice. The HEMO-FISS-CdV is the Spanish version of the original HEMO-FISS-QoL by Abramowitz. The questionnaire consists of 23 items organised in 4 dimensions (physical, psychological, defecation and sexuality). The reliability of the new tool was assessed by determining internal consistency using Cronbach's alpha and Guttman's coefficient. It was also correlated with the quality of life questionnaire SF12 version 2. The Cronbach's alpha obtained for our questionnaire (HEMO-FISS-CdV) was 0.951 (ICC 95% +-0.016), with a range between 0.935 and 0.967. The Guttman two-half coefficient had a value of 0.910. Patients with internal haemorrhoids, anal fissure or both had higher values on the HEMO-FISS-CdV questionnaire than patients without internal haemorrhoids and these differences were significant (p<0.05). Both diseases have a negative impact on patients' quality of life. The HEMO-FISS-CdV questionnaire provides a tool in Spanish that easily and specifically assesses the impact of haemorrhoidal disease and anal fissure on quality of life.
PubMed: 38767040
DOI: 10.17235/reed.2024.10308/2024 -
International Journal of Surgery Case... Jun 2024Intussusception is uncommon in older patients, making its diagnosis challenging and necessitating a high level of clinical suspicion. While pediatric intussusception...
INTRODUCTION AND IMPORTANCE
Intussusception is uncommon in older patients, making its diagnosis challenging and necessitating a high level of clinical suspicion. While pediatric intussusception typically presents with a triad of symptoms including abdominal pain, bloody diarrhea, and an abdominal mass, the majority of adult patients experience chronic abdominal pain and partial obstruction. Consequently, the diagnosis of adult intussusception may be delayed due to the similarity in presentation with other conditions.
CASE PRESENTATION
In this article, we have presented a 13-year-old boy with chronic and refractory anal fissure. The patients also complained of constipation for a year, intermittent abdominal pain, and bloating. Although he was treated with conservative laxative medications, the constipation was not relieved. Incidentally, a colocolic intussusception was found through an MRI.
CLINICAL DISCUSSION
We have provided a comprehensive description of an unexpected intussusception at an uncommon age which was found incidental. Medical literature was reviewed for better optimal planning in surgery.
CONCLUSION
Intussusception in a teenager is unexpected, and this case shows the importance of considering it even in the presence of nonspecific symptoms. This case serves as a reminder to healthcare professionals to consider intussusception as a potential diagnosis in similar cases.
PubMed: 38759399
DOI: 10.1016/j.ijscr.2024.109759 -
Medicine May 2024The efficacy of surgical intervention for perianal infection in patients with hematologic malignancies is not well established. Therefore, our study aimed to investigate...
The efficacy of surgical intervention for perianal infection in patients with hematologic malignancies is not well established. Therefore, our study aimed to investigate the clinical efficacy and complications of surgical treatment of perianal infection in patients with hematologic malignancies. This retrospective study included patients with hematological malignancies who were diagnosed with perianal infections and treated at the China Aerospace Science & Industry Corporation 731 Hospital between 2018 and 2022. Patient characteristics, hematological data, surgical intervention, and complications, including recurrence and mortality, were analyzed. This study included 156 patients with leukemia aged 2 months to 71 years who were treated surgically for perianal infection, comprising 94 males and 62 females. Perianal infection included 36 cases of abscesses, 91 anal fistulas, and 29 anal fissures accompanied by infection. A total of 36 patients developed severe complications postoperatively, including 4 patients who died, 6 patients with severe incision bleeding, 18 patients with severe pain, 6 patients with sepsis, 12 patients who needed reoperation, 15 patients with hospitalization for more than 2 weeks, and 3 patients with anal stenosis; none of the patients developed anal incontinence. Additionally, risk factors for postoperative complications of perianal infection in patients with hematologic malignancies include leukopenia, agranulocytosis, thrombocytopenia, depth of abscess and not undergone an MRI. Surgical intervention may improve the prognosis of patients with perianal abscess formation, particularly in patients who show no improvement with medical therapy and those who develop perianal sepsis. Granulocytopenia and thrombocytopenia should be improved before surgery, which can significantly reduce postoperative complications. Although these findings are from a case series without a comparator, they may be of value to physicians because to the best of our knowledge, no randomized or prospective studies have been conducted on the management of perianal infections in patients with hematological malignancies.
Topics: Humans; Male; Female; Retrospective Studies; Middle Aged; Adult; Aged; Hematologic Neoplasms; Abscess; Adolescent; Child; Young Adult; Anus Diseases; Child, Preschool; Postoperative Complications; Infant; Rectal Fistula; Treatment Outcome; Fissure in Ano
PubMed: 38728504
DOI: 10.1097/MD.0000000000038082 -
American Journal of Men's Health 2024Benign anorectal diseases such as hemorrhoidal disease, anal fissure, anal pruritus, perianal abscess, and fistula are the most common ones. The aim of this study was to...
Benign anorectal diseases such as hemorrhoidal disease, anal fissure, anal pruritus, perianal abscess, and fistula are the most common ones. The aim of this study was to assess sexual function in patients after surgery for benign anorectal diseases. Sixty-one male patients with perianal fistulas, operated on at Department of General Surgery, Faculty of Medicine, completed a self-administered questionnaire including the International Index of Erectile Function (IIEF) score. The median IIEF score of the postoperative patients was significantly higher (24, range [10-25]) than that of preoperative patients (22, range [5-25]), < .0001. Sexual function is significantly influenced by surgery for benign anorectal diseases.
Topics: Humans; Male; Adult; Middle Aged; Surveys and Questionnaires; Anus Diseases; Young Adult; Aged; Rectal Diseases; Rectal Fistula; Erectile Dysfunction
PubMed: 38712744
DOI: 10.1177/15579883241252016 -
Journal of the Anus, Rectum and Colon 2024Lateral internal sphincterotomy is a conventional surgical intervention for chronic anal fissures, yet the potential for postoperative anal incontinence underscores the...
OBJECTIVES
Lateral internal sphincterotomy is a conventional surgical intervention for chronic anal fissures, yet the potential for postoperative anal incontinence underscores the need for an alternative approach. This study aimed to evaluate the outcomes of patients with chronic fissures who underwent a combination of fissurectomy, vertical non-full thickness midline sphincterotomy (VNMS), and mucosal advancement flap (MAF), as a means of mitigating the risk of incontinence.
METHODS
This retrospective analysis included forty-six consecutive patients with chronic anal fissures, unresponsive to topical diltiazem, who underwent fissurectomy combined with VNMS and MAF between April 2018 and May 2023. Primary outcome measures encompassed fissure healing rates. Continence was assessed using the Fecal Incontinence Severity Index (FISI), and manometric assessments were conducted before the procedure and three months postoperatively.
RESULTS
With a median follow-up of 27 months, there were no postoperative complications, and the overall fissure healing rate reached 96% (44/46). At three months post-procedure, FISI scores were reduced to 0, with no instances of fecal soiling. Anal resting pressure exhibited a significant reduction at 3 months [pre-op: 133 (95% CI, 128-150) vs. 3 mo: 109 (95% CI, 100-117) cmHO; = 0.01]. Similarly, maximum anal squeeze pressure showed a significant decrease three months post-surgery [pre-op: 317 cmHO (95% CI, 294-380) vs. 3 mo: 291 cmHO (95% CI, 276-359), = 0.03].
CONCLUSIONS
The combination of fissurectomy, VNMS, and MAF proved to be an effective approach for chronic anal fissures, yielding favorable medium-term outcomes without postoperative anal incontinence.
PubMed: 38689786
DOI: 10.23922/jarc.2023-072 -
The Pan African Medical Journal 2024Bowel transit disturbances favored by pregnancy and injuries during childbirth would be triggering or aggravating factors for anal pathologies. The objective of this...
Bowel transit disturbances favored by pregnancy and injuries during childbirth would be triggering or aggravating factors for anal pathologies. The objective of this work was to study the epidemiology, diagnosis, and treatment of anal pathologies during pregnancy and 6 weeks after delivery. We carried out a prospective, multi-centric, and analytical study in 10 obstetric units in Bamako from June 1, 2019, to May 31, 2020. After informed consent, we enrolled all first-trimester pregnant women admitted to the hospitals and who were followed up through the postpartum. We conducted a rectal examination in each participant and an anoscope in those with an anal symptom. Hemorrhoidal diseases were diagnosed in the case of external hemorrhoids (thrombosis or prolapse) or internal hemorrhoids. During the study period, we followed up 1,422 pregnant women and we found 38.4% (546) with anal pathologies (hemorrhoidal diseases in 13% (192), anal fissure in 10.5% (150) and anal incontinence in 8.6% (123). Risk factors for the hemorrhoidal disease were age of patient ≥30 years old aRR=5.77, 95% CI 4.57-7.34; p=0.000; a existence of chronic constipation aRR=2.61, 95% CI 1.98-3.44; p=0.000; newborn weight >3500 g aRR= 1.61, 95% CI 1.25-2.07; p=0.000 and fetal expulsion time >20 minutes aRR= 6.04, 95% CI 5.07-7.27; p=0.000. The clinical signs observed were constipation, anal pain, bleeding, and pruritus. The treatment was based on counseling on hygiene and diet, the use of laxatives, local topicals, and analgesics along perineal rehabilitation. Anal pathologies were common during pregnancy and 6 weeks after delivery. Pregnant women must be screened systematically for such pathologies. Early diagnostic and appropriate treatment would reduce serious complications.
Topics: Humans; Female; Pregnancy; Mali; Adult; Prospective Studies; Hemorrhoids; Pregnancy Complications; Young Adult; Risk Factors; Anus Diseases; Postpartum Period; Fissure in Ano; Fecal Incontinence; Constipation; Follow-Up Studies; Adolescent
PubMed: 38681103
DOI: 10.11604/pamj.2024.47.66.36210 -
Medical Science Monitor : International... Apr 2024BACKGROUND Chronic anal fissure is a common condition that causes pain and discomfort and has a significant impact on quality of life. When conservative management... (Comparative Study)
Comparative Study
BACKGROUND Chronic anal fissure is a common condition that causes pain and discomfort and has a significant impact on quality of life. When conservative management fails, surgical sphincterotomy can be successful. This retrospective study from a single center in Turkey included 188 patients with chronic anal fissures and aimed to compare outcomes from open and closed sphincterotomy. MATERIAL AND METHODS This retrospective study included 188 patients treated with lateral internal sphincterotomy (LIS) for chronic anal fissure between January 2015 and December 2021 in our hospital. Open LIS procedure was performed in 91 patients and closed LIS was performed in 97 patients. Demographic characteristics, postoperative complications, and recurrence were compared for these 2 methods. RESULTS Of the 188 patients included in the study, 47.9% were women and 52.1% were men. The mean age was 42.9 (20-84) years. In the open LIS group, recurrence occurred in 2 patients (2.19%), and no incontinence was observed. In the closed LIS group, recurrence occurred in 3 patients (3%; P=0.703), and incontinence developed in 5 patients (5.15%; P=0.035). CONCLUSIONS Comparing the 2 methods used in chronic anal fissure surgery, and considering the recurrence and risk of incontinence, the most feared outcome by the patient and surgeon, open LIS stands out as a superior technique, especially in young male patients.
Topics: Humans; Fissure in Ano; Male; Female; Adult; Middle Aged; Retrospective Studies; Aged; Treatment Outcome; Chronic Disease; Sphincterotomy; Recurrence; Anal Canal; Aged, 80 and over; Turkey; Postoperative Complications; Quality of Life; Young Adult
PubMed: 38679898
DOI: 10.12659/MSM.944127