Fissurectomy with posterior midline internal sphincterotomy and anoplasty in the management of chronic posterior anal fissures

Acharya, Amulya Mohan; Das, Subrata K.

doi:10.1016/j.cmrp.2019.11.003

Cited by 1 publication

(3 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Ningún factor clínico o patológico predijo la cura. En el análisis de subgrupos, las tasas generales de cura de la fistulotomía subcutánea no fueron estadísticamente más bajas de 46 % (6/13) comparados con la fistulotomía que involucró las fibras del esfínter anal interno en 72 % (18/25; p = 0, 16). No hubo diferencia en el tiempo de cicatrización [fistulotomía subcutánea 6,7 meses (5,2-8,4) conparada a la fistulotomía y esfínterotomía parcial interna a 5,1 meses (2,1-7,0); p = 0,36].…”

Section: Principales Medidas De Resultadounclassified

“…11,12 Although some have suggested the role of fissurectomy or anal dilation in the management of chronic anal fissure, these were not performed in our series. 1,[13][14][15][16] Future research should focus on the use of topical agents and BT injection in improving the probability of healing. Prospective data may elucidate whether immediate postoperative initiation of topical agents or intraoperative BT injection has the potential to change the disease course.…”

Section: Discussionmentioning

confidence: 99%

“…11,12 Although some have suggested the role of fissurectomy or anal dilation in the management of chronic anal fissure, these were not performed in our series. 1,13–16…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

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

Adams

Mirocha

Fleshner

et al. 2023

Diseases of the Colon &Amp; Rectum

View full text Add to dashboard Cite

BACKGROUND: A subset of chronic anal fissures beget focal infection, leading to concomitant fistula. The optimal management of fissure-associated fistula is unknown. OBJECTIVE: This study aimed to characterize healing rates and effects of fistulotomy in fissure-associated fistula. DESIGN: Retrospective study. SETTING: Urban tertiary center. PATIENTS: Adults who underwent fistulotomy for a fistula associated with a chronic anal fissure were included in the study. However, those with Crohn’s disease, a history of lateral internal sphincterotomy, and a fistula not amenable to fistulotomy were excluded. INTERVENTIONS: Patients were managed with fistulotomy. Fissures were otherwise managed conservatively with a step-up approach. MAIN OUTCOME MEASURES: The primary end point was healing, defined as resolution of symptoms and both fistula and fissure wounds within 1 year. Subgroup analysis compared those who underwent subcutaneous fistulotomy (group A) with those who underwent fistulotomy involving anal sphincter fibers (group B). RESULTS: Twenty-four of 38 patients (63%) healed with a median overall follow-up of 6.6 months (4.2–14.1). The overall median time to healing was 4.4 months (2.2–6.0). No clinical or pathologic factors predicted healing. In subgroup analysis, overall subcutaneous fistulotomy healing rates were nonstatically lower at 46% (6/13) compared to fistulotomy involving anal sphincter fibers at 72% (18/25; p = 0.16). There was no difference in time to healing (subcutaneous fistulotomy, 6.7 mo [5.2–8.4] vs fistulotomy involving sphincter, 5.1 mo [2.1–7.0]; p = 0.36). LIMITATIONS: The limitations include treatment bias, with increased utilization of chemical sphincter-relaxing agents in those who did not heal. Findings are not applicable to complex fistulas, Crohn’s disease, or atypical fissures. CONCLUSIONS: Patients presenting with chronic fissure and associated subcutaneous, intersphincteric, or low transphincteric fistula are successfully managed with fistulotomy. Patients with a subcutaneous fistula tract exhibited nonstatistically significantly lower rates of healing. See Video Abstract at http://links.lww.com/DCR/C145. EFICACIA DE LA DIVISIÓN ESFINTÉRICA DURANTE LA FISTULOTOMÍA EN CASOS DE FÍSTULA ASOCIADA A FISURA ANAL ANTECEDENTES: Ciertos subgrupos de fisuras anales crónicas ocasionan infección localizada, induciendo la aparición de una fístula anal concomitante. Se desconoce el manejo óptimo de la fístula concomitante a una fisura anal. OBJETIVO: Se trata de caracterizar las tasas de curación y el efecto de la fistulotomía en el tratamiento de la fístula concomitante a la fisura anal. DISEÑO: Estudio retrospectivo. EMPLAZAMIENTO: Centro terciario urbano. PACIENTES: Adultos sometidos a fistulotomía por una fístula concomitante a una fisura anal crónica. Se excluyeron la enfermedad de Crohn, el antecedente de una esfinterotomía lateral interna y las fístulas no susceptibles de fistulotomía. INTERVENCIONES: Los pacientes fueron manejados con una fistulotomía clasica. Por lo dem...

show abstract

Section: Principales Medidas De Resultadounclassified