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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 -
La Clinica Terapeutica 2023Crypts are small anatomical structures situated between the anal papillae, which do not cause any symptoms unless they become inflamed. Cryptitis is a localized...
INTRODUCTION
Crypts are small anatomical structures situated between the anal papillae, which do not cause any symptoms unless they become inflamed. Cryptitis is a localized infection of one or more of the anal crypts.
CASE PRESENTATION
A 42-year-old woman presented to our practice, complaining intermittently of anal pain and pruritus ani over a span of 1 year. She was referred multiple times to various surgeons, and she was treated conservatively for anal fissure without any evident improvement. The referred symptoms were increased often after defecation. Under general anesthesia, a hooked fistula probe was introduced into the inflamed anal crypt and the whole length of the crypt was layed open.
CONCLUSION
Anal cryptitis is a misdiagnosed condition. The un-specific symptomatology of the disease can easily mislead. The clinical suspicion is fundamental for the diagnosis. Patient's history, digital ex-amination, and anoscopy are essential for the diagnosis of anal cryptitis.
Topics: Female; Humans; Adult; Anal Canal; Fissure in Ano; Diagnostic Errors
PubMed: 37199352
DOI: 10.7417/CT.2023.2522 -
Journal of Experimental Pharmacology 2022Although ulcerative proctitis (UP) and anal fissure (AF) are common anorectal diseases, there are no appropriate experimental models to screen the drugs intended for...
BACKGROUND
Although ulcerative proctitis (UP) and anal fissure (AF) are common anorectal diseases, there are no appropriate experimental models to screen the drugs intended for these conditions. In this context, existing experimental models mimicking these diseases were modified and the polyherbal formulation, HPLF-111624 was evaluated in these models.
OBJECTIVE
To establish animal model for UP and AF and to evaluate polyherbal formulation, HPLF-111624 in these disease models.
METHODS
An experimental model of UP was selected based on the modification of the ulcerative colitis model using different concentrations of acetic acid. The concentration used for induction were 2.5%, 5% and 10% v/v and different weights used to induce AF were 25 g, 50 g and 100 g, which were selected based on the severity of inflammation, fecal score, gross pathology, and histopathological evaluation. Furthermore, these animal models were used to evaluate the efficacy of HPLF-111624, a polyherbal formulation known to be beneficial in anal diseases.
RESULTS
Acetic acid at 5% produced typical pathological changes that resembled UP, with a significant increase in the fecal score, gross lesion, and histopathological changes. Similarly, among the three weights, physical injury with a 100 g weight produced significant changes in the histopathological score in the model of AF. Intervention with HPLF-111624 at doses of 250 and 500 mg/kg b.wt., showed a reduction in the inflammatory cytokines and a significant improvement in the histopathological findings in both the conditions.
CONCLUSION
The results showed that the modified experimental models for UP and AF resemble the human pathological conditions and are simple, versatile and may be used for screening drugs intended for these conditions. Intervention with HPLF-111624 was found to be effective in improving the pathological state of UP and AF.
PubMed: 35509969
DOI: 10.2147/JEP.S345599 -
Ugeskrift For Laeger Oct 2017Anal fissure is a common ailment, however, the pathophysiology and optimal treatment strategy is unclear. Anal fissures may be classified as acute or chronic. Acute... (Review)
Review
Anal fissure is a common ailment, however, the pathophysiology and optimal treatment strategy is unclear. Anal fissures may be classified as acute or chronic. Acute fissures are effectively treated and prevented with conservative measures, whereas chronic fissures typically require medical or surgical therapy. Invasive interventions have superior healing rates compared with local medical therapies, but may cause persistent incontinence. New interventions are constantly introduced and may be of value in patients with high risk of incontinence, but more evidence is currently needed.
Topics: Acute Disease; Chronic Disease; Fissure in Ano; Humans; Imaging, Three-Dimensional; Ultrasonography
PubMed: 29076452
DOI: No ID Found -
American Family Physician Mar 2016
Review
Topics: Chronic Disease; Colonoscopy; Digestive System Surgical Procedures; Fissure in Ano; Humans
PubMed: 26977835
DOI: No ID Found -
The British Journal of General Practice... Aug 2019
Topics: Administration, Topical; Botulinum Toxins, Type A; Conservative Treatment; Dietary Fiber; Fissure in Ano; Humans; Nitroglycerin; Ointments; Pain; Physical Examination; Practice Guidelines as Topic; Primary Health Care; Referral and Consultation
PubMed: 31345824
DOI: 10.3399/bjgp19X704957 -
International Journal of Surgery... Mar 2023
Meta-Analysis
Botulinum toxin as a promising surgical strategy for chronic anal fissure: do the dose and injection site matter? Comparison of doses and injection sites of botulinum toxin for chronic anal fissure: A systematic review and network meta-analysis of randomized controlled trials.
Topics: Humans; Fissure in Ano; Network Meta-Analysis; Randomized Controlled Trials as Topic; Botulinum Toxins, Type A; Anal Canal; Chronic Disease; Treatment Outcome
PubMed: 36906767
DOI: 10.1097/JS9.0000000000000022 -
Frontiers in Surgery 2021Surgery for chronic anal fissure is challenging for every proctologist. Solving the pain by guaranteeing rapid and effective healing is the objective, but what is the...
Surgery for chronic anal fissure is challenging for every proctologist. Solving the pain by guaranteeing rapid and effective healing is the objective, but what is the price to pay today in functional terms? Though this result is nowadays partially achievable through interventions that include the execution of an internal sphincterotomy among the procedures, it is necessary to underline the high rate of patients who can present faecal incontinence. The aim of this study is to explore the effectiveness of scanner-assisted CO laser fissurectomy. From April 2021 to September 2021, all consecutive patients who affected by chronic anal fissure suitable for surgery, meeting the inclusion and exclusion criteria, were evaluated. All planned data were recorded before surgery, then at 24 h, 1 week, and 1 month follow-up. A scanner-assisted CO laser was used in this study to achieve a smooth and dried wound with a minimal tissue thermal damage, to ensure good postsurgical pain control, rapid and functional, elastic and stable healing, and to prevent potential relapses. Paracetamol 1 g every 8 h was prescribed for the first 24 h and then continued according to each patient's need. Ketorolac 15 mg was prescribed as rescue. Mean pain intensity ≤3, considered as the principal endpoint, was recorded in 26 out of the 29 patients who enrolled in the study with a final success rate of 89.7% at 1-month follow-up. Pain and anal itching showed a statistically significant reduction while bleeding, burning, and maximum pain, and REALIS score showed a reduction too at the end of the follow-up period. Reepithelisation proved to be extremely fast and effective: 22 of 29 (75.9%) showed a complete healing and 5 showed a partial reepithelisation at 1-month follow-up. Outcomes of this study showed that it is undoubtedly necessary to change the surgical approach in case of anal fissure. The internal sphincterotomy procedure must be most of all questioned, where the availability of cutting-edge technological tools must be avoided and offered only in selected cases. Scanner-assisted CO laser showed great results in terms of pain control and wound healing, secondary to an extremely precise ablation, vaporisation, and debridement procedures with minimal lateral thermal damage.
PubMed: 35028310
DOI: 10.3389/fsurg.2021.799607 -
British Medical Journal Jun 1973In 33 patients with an intersphincteric abscess continuous anal pain was the commonest symptom and a lump in the wall of the anal canal the commonest sign.The importance...
In 33 patients with an intersphincteric abscess continuous anal pain was the commonest symptom and a lump in the wall of the anal canal the commonest sign.The importance of this condition as a cause of persistent undiagnosed anal pain is stressed.
Topics: Abscess; Adult; Age Factors; Aged; Anus Diseases; Female; Fissure in Ano; Humans; Male; Middle Aged; Pain; Sex Factors
PubMed: 4714472
DOI: 10.1136/bmj.2.5865.537 -
Frontiers in Surgery 2022Today's gold standard for treating chronic anal fissure is the Lateral Internal Sphincterotomy (LIS). Botulinum Toxin (BoNT) injection is, on the other hand, an...
OBJECTIVE
Today's gold standard for treating chronic anal fissure is the Lateral Internal Sphincterotomy (LIS). Botulinum Toxin (BoNT) injection is, on the other hand, an alternative treatment for patients who do not want to have surgical treatment, patients undergoing chemotherapy, patients of high risk for surgery, and those who have the risk of anal incontinence (e.g., elderly, past anorectal surgery, vaginal multiple births, etc.). The aim of this study is to compare the effectiveness of BoNT and redo-LIS for treatment of post-LIS recurrent chronic anal fissure, and reveal differences if any.This study aims to compare redo-LIS and BoNT injection for treating post-LIS recurrent anal fissure.
MATERIAL AND METHOD
Nineteen patients who received LIS treatment and then redo-LIS or BoNT injection due to recurrence in the follow-up were included in this study. Group I (redo-LIS group) include 11 patients and group 2 (BoNT group) includes 8 patients. Their data on age, sex, anal incontinence scores and pain (VAS score) score as well.
RESULTS
During the 3-month post-surgery follow-up period, there was statistically significant difference ( < 0.01) between groups by pain. No deterioration in the incontinence scores of patients in the group during the 6-month post-surgery period.
CONCLUSION
This study demonstrates that redo lateral internal sphincterotomy (LIS) is a reliable method for patients who received LIS but developed recurrent chronic anal fissure, and achieves successful results in terms of recurrence and relief of pain.
PubMed: 36204342
DOI: 10.3389/fsurg.2022.988082