Operative and medical treatment of chronic anal fissures-a review and network meta-analysis of randomized controlled trials

Ebinger, Sabrina M.; Hardt, Julia; Warschkow, René; Schmied, Bruno M.; Herold, Alexander; Post, Stefan; Marti, Lukas

doi:10.1007/s00535-017-1335-0

Cited by 74 publications

(56 citation statements)

References 62 publications

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“…After internal sphincterotomy, most of the chronic anal fissure take 4-8 weeks for complete healing 7,17 , although Oettle GJ reported complete healing in 2 weeks but his sample included only 12 patients. 18 None of our patient had complete healing at the end of 2 nd week.…”

Section: Discussionmentioning

confidence: 99%

“…5,6 Therefore, the aim of treatment strategies is to reduce the sphincter tone which in turn increases local vascularity, with either medical agents, such as glyceryl trinitrate, calcium channel blockers and botulinum toxin, or surgical interventions, such as lateral internal sphincterotomy (LIS). 7 Internal sphincter is formed by circular muscle fibers and dividing it at one point of the circle opens up, relaxes and decreases the tone of the internal sphincter, which is the rationale for doing unilateral LIS in chronic anal fissures. Dividing the internal sphincter at two places may actually relax the sphincter more effectively and help in faster healing and recovery.…”

Section: Introductionmentioning

confidence: 99%

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Outcome of bilateral versus unilateral lateral internal sphincterotomy for chronic anal fissures

Mushtaque¹,

Bacha²,

Rashid

et al. 2019

Int Surg J

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Background: Gold standard treatment for chronic anal fissure is lateral internal sphincterotomy (LIS) which is usually performed at a single location. This randomized study compares bilateral to unilateral lateral internal sphincterotomy.Methods: Patients were randomized into two equal groups (64 each) to undergo either bilateral (Group A) or unilateral (Group B) open lateral internal sphincterotomy (LIS). Comparative study was done in terms of symptomatic relief of pain, incontinence, complete healing of fissure, and recurrence. Chi-square test was used as a test of significance.Results: Both groups had comparable demographic and clinical characteristics. Mean operative time for was longer for bilateral LIS (P-value <0.05). Mean pain score (VAS) in bilateral LIS group was lower in early post-operative period (P-value <0.05). At the end of 4th week 65.6% of patients in bilateral LIS group and 56.25% of patients in unilateral LIS group had completely healed fissures (P-value <0.05). Mean Wexner score for incontinence was comparable, while significant decrease in resting anal pressure was noted at 1 month in BLIS group. There was one recurrence in unilateral LIS group.Conclusions: Bilateral LIS resulted in better outcome in terms of early pain relief, early reduction of anal pressures, complete healing rate in 4 weeks with no recurrence. It does not increase the risk of incontinence and has better patients’ satisfaction as compared to unilateral LIS.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Outcome of bilateral versus unilateral lateral internal sphincterotomy for chronic anal fissures

Mushtaque¹,

Bacha²,

Rashid

et al. 2019

Int Surg J

View full text Add to dashboard Cite

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“…Medical management has a much-reduced incidence of the dreaded complication of faecal incontinence but has a higher recurrence rate (around 50% for medical management as compared to 3-6% for LIS) [23][24][25]. This recurrence rate is similar for both calcium channel blockers and nitrates.…”

Section: Pharmacological Managementmentioning

confidence: 99%

“…Other side effects include perianal itching and dermatitis [24]. Medical therapies have been shown to have recurrence rates as high as 50% [25].…”

Section: Overview and Comparison Of Side Effectsmentioning

confidence: 99%

Fissure-In-ANO

Fahadullah¹,

Peirce²

2018

Proctological Diseases in Surgical Practice

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This chapter provides a summary of the aetiology, diagnosis, investigation and management of anal fissure. It gives an overview of clinical anatomy and pathophysiology related to anal fissure. Focusing on anal sphincter hypertonia as the key factor for anal fissure progression, the chapter draws attention to perpetuating factors that contribute to a vicious cycle of fissure non-healing and addresses management options for these factors. This chapter also looks at the way how different treatment options for anal fissure emerged over time and uses evidence-based medicine to compare these options."Fissure-in-ANO" concludes with summarising the treatment options and suggesting an algorithm for management of acute and chronic anal fissures.

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“…The change in practice was extensively studied and represented in recent reviews and meta-analyses. It has been confirmed that manual anal stretch had higher rate of incontinence and was not more effective than internal sphincterotomy [6][7][8].…”

Section: Introductionmentioning

confidence: 98%

The Long-term Effect of Standardized Anal Dilatation for Chronic Anal Fissure on Anal Continence

2021

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Purpose: For the past several decades, internal anal sphincterotomy has generally been considered to be the standard operation for an anal fissure. However, wound complications inherent in this operation forced surgeons to look for an alternative form of treatment. The aim of our study was to evaluate the long term outcome of anal dilatation for chronic anal fissure, especially possible negative impact on anal sphincter function.Methods: The study was approved by the Local Institutional Review Board and given a waiver of written consent. A phone call survey was undertaken among a group of consecutive patients who had an anal dilatation by standardized technique for chronic anal fissure for the period between 2000 -2016. The survey included medical, obstetrical and surgical-related data, Wexner fecal incontinence score, recurrence of the anal fissure and the need for additional medical intervention. 548 patients were identified after limitations of age, concomitant pathology and procedures that were applied to hospital computerized database. 85 patients (Group A) agreed to participate in the survey and 463 patients did not.Results: There were no differences between groups in demographic information and medical records data, therefore Group A may well represent a satisfactory sample of the whole group. The interval between the procedure and the survey was 6.8±2.7 years. The Wexner Incontinence Score was 0 in 94% of patients.Conclusions: Anal dilatation, performed in a systematic and standardized way, has successful outcome with no complications and has no clear long-term negative impact on anal sphincter function.

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Operative and medical treatment of chronic anal fissures-a review and network meta-analysis of randomized controlled trials

Cited by 74 publications

References 62 publications

Outcome of bilateral versus unilateral lateral internal sphincterotomy for chronic anal fissures

Outcome of bilateral versus unilateral lateral internal sphincterotomy for chronic anal fissures

Fissure-In-ANO

The Long-term Effect of Standardized Anal Dilatation for Chronic Anal Fissure on Anal Continence

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