Efficacy of Anal Sphincter Division During Fistulotomy in Anal Fissure Associated Fistula

Adams, Evan; Mirocha, James; Fleshner, Phillip; Zaghiyan, Karen N.

doi:10.1097/dcr.0000000000002700

Cited by 5 publications

(2 citation statements)

References 15 publications

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“…Adams et al. [68] looked at healing rates of anal fissures associated with a fistulae and found fistulotomy was associated with healing. However, the data is very poor.…”

Section: Resultsmentioning

confidence: 99%

The Association of Coloproctology of Great Britain and Ireland guideline on the management of anal fissure

Cross,

Brown,

Kleijnen

et al. 2023

Colorectal Disease

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AimThe management of anal fissure: ACPGBI position statement was written 15 years ago. [KLR Cross et al., Colorectal Dis, 2008]. Our aim was to update the guideline and provide recommendations on the most effective treatment for patients with anal fissures utilising a multidisciplinary, rigorous guideline methodology.MethodsThe development process consisted of six phases. In phase 1 we defined the scope of the guideline. The patient population included patients with acute and chronic anal fissure. The target group was all practitioners (primary and secondary care) treating patients with fissures and, in addition, healthcare workers and patients who desired information regarding fissure management. In phase 2 we formed a guideline development group (GDG) including a methodologist. In phase 3 review questions were formulated, using a reversed PICO process, starting with possible recommendations based on the GDG's knowledge. In phase 4 a comprehensive literature search focused on existing systematic reviews addressing each review question, supplemented by more recent studies if appropriate. In phase 5 data were extracted from the included papers and checked by the GDG. If indicated, meta‐analysis of systematic review data was updated by the GDG. During phase 6 the GDG members decided what recommendations could be made based on the evidence in the literature and strength of the recommendation was assessed using ‘grade’.ResultsThis guideline is divided into two sections: Primary care which includes (i) diagnosis; (ii) basic treatment; (iii) topical treatment; and secondary care which includes (iv) botulinum toxin therapy; (v) surgical intervention and (vi) special situations (including pregnancy and breast‐feeding patients, children, receptive anal intercourse and low‐pressure fissures). A total of 23 recommendations were formulated. A new term clinically healed was described by the GDG.ConclusionThis guideline provides an up‐to‐date evidence‐based summary of the current knowledge of the management of anal fissure and may serve as a useful guide for clinicians as well as a potential reference for patients.

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“…Adams et al. [68] looked at healing rates of anal fissures associated with a fistulae and found fistulotomy was associated with healing. However, the data is very poor.…”

Section: Resultsmentioning

confidence: 99%

The Association of Coloproctology of Great Britain and Ireland guideline on the management of anal fissure

Cross,

Brown,

Kleijnen

et al. 2023

Colorectal Disease

View full text Add to dashboard Cite

show abstract

“…However, the optimal treatment standard for ssure-associated stulas remains undetermined. Recent research by Adams et al highlights that a considerable proportion of patients (37%) did not experience healing following stulotomy in ssure-associated stulas [24].…”

Section: Discussionmentioning

confidence: 99%

Enhanced approach to treating chronic anal fissures: Fissurectomy with vertical non-full-thickness midline sphincterotomy and mucosal advancement flap

Tsunoda,

Kusanagi

2023

Preprint

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Purpose 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) cm H2O; p = 0.01]. Similarly, maximum anal squeeze pressure showed a significant decrease three months post-surgery [pre-op: 317 cmH2O (95% CI, 294−380) vs. 3 mo: 291 cmH2O (95% CI, 276−359), p = 0.03]. Conclusion 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.

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Improving High Anal Fistula Management: Insights from Transanal Opening of Intersphincteric Space (TROPIS) - A Retrospective Cohort Study

Zhan

2024

Preprint

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Objective This retrospective cohort study assessed the therapeutic efficacy and safety profile of the transanal opening of the intersphincteric space (TROPIS) procedure for the treatment of complex high anal fistulas. Methods A retrospective cohort study was conducted, including 131 patients who underwent TROPIS surgery at the First Hospital of Harbin from May 2023 to April 2024. A control group of 124 patients with high anal fistulas was treated with open drainage and seton placement by the same attending physician at the same hospital from January 2022 to April 2023. The study compared clinical outcomes, postoperative pain, wound healing, anal sphincter function, anorectal manometry, quality of life, postoperative complications, and recurrence rates between the two groups. Results The TROPIS group demonstrated a total effectiveness rate of 100.0%, significantly surpassing the control group's rate of 84.8% (P < 0.05). Postoperative pain, wound healing duration, and anal sphincter scores were markedly lower in the TROPIS group compared to the control group (P < 0.05). Both groups experienced a significant reduction in Wexner incontinence scores postoperatively, with the TROPIS group showing a more pronounced improvement (P < 0.05). Anorectal pressures, encompassing both resting and maximum pressures, were significantly elevated in the TROPIS group relative to the control group within one month postoperatively (P < 0.05). Quality of life, as assessed by the SF-36 questionnaire, indicated a more substantial improvement in the TROPIS group than in the control group (P < 0.05). Furthermore, the rate of postoperative complications was notably lower in the TROPIS group than in the control group (P < 0.05). Conclusion TROPIS has demonstrated superior clinical outcomes in the management of high anal fistulas, characterized by diminished postoperative pain, enhanced anal sphincter functionality, improved quality of life, and a reduction in postoperative complications. These results endorse the continued promotion and application of TROPIS as a viable treatment modality for high anal fistulas.

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Efficacy of Anal Sphincter Division During Fistulotomy in Anal Fissure Associated Fistula

Cited by 5 publications

References 15 publications

The Association of Coloproctology of Great Britain and Ireland guideline on the management of anal fissure

The Association of Coloproctology of Great Britain and Ireland guideline on the management of anal fissure

Enhanced approach to treating chronic anal fissures: Fissurectomy with vertical non-full-thickness midline sphincterotomy and mucosal advancement flap

Improving High Anal Fistula Management: Insights from Transanal Opening of Intersphincteric Space (TROPIS) - A Retrospective Cohort Study

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