Operative procedures for fissure in ano

Nelson, Richard L.; Chattopadhyay, Arpita; Brooks, William D.; Platt, Isobel; Paavana, Thumri; Earl, Sophie

doi:10.1002/14651858.cd002199.pub4

Cited by 84 publications

(26 citation statements)

References 44 publications

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“…Our study has shown a healing rate of 71 % at 6 weeks for topical diltiazem and a much superior rate for LIS (96 %). The healing rate for LIS as reported in other studies range from 92 to 100 % [5,23,24].…”

Section: Discussionmentioning

confidence: 84%

“…The American Society of Colon and Rectal Surgeons (ASCRS) recommend conservative management with stool softeners, high fibre diet and sitz bath as the initial line of management [4]. A Cochrane review of anal fissure treatment had shown that topical and injected therapies are only marginally effective to placebo therapy and recommended lateral internal sphincterotomy (LIS) as the gold standard for chronic anal fissure (CAF) [5]. The main drawback of LIS is the potential complication of incontinence to flatus or faecal matter.…”

Section: Introductionmentioning

confidence: 99%

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Randomised Prospective Controlled Trial of Topical 2 % Diltiazem Versus Lateral Internal Sphincterotomy for the Treatment of Chronic Fissure in Ano

Vaithianathan

Panneerselvam²

2014

Indian J Surg

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Fissure in ano is a very common disorder of the anorectal region. Internal sphincter hypertonia with decreased relaxation coupled with mucosal ischemia of posterior anal canal are the major pathologies in chronic anal fissure (CAF). Though lateral internal sphincterotomy (LIS) remains the gold standard of treatment for the disease, it is accompanied by the potential complication of incontinence to both flatus and faecal matter. The aim of our study was to explore the role of topical diltiazem as an effective and a safe alternative to sphincterotomy for chronic anal fissure. Ninety patients with CAF were randomly assigned to group A and group B, with 45 patients each. Group A patients received 2 % diltiazem topical application, twice daily, and group B patients underwent LIS. All the patients were reviewed at first, fourth and sixth week after initiation of treatment. Visual analogue scores for pain and healing of fissure by visual inspection were recorded and compared. In group A, 71 % had complete healing of fissure at 6 weeks, with fair amount of pain relief (mean VAS-3.38), and in group B, 96 % showed healing of fissure, with excellent pain relief (mean VAS-1.87). Headache and flushing were noted in two patients in group A while no patients in group B developed incontinence. We conclude that LIS is more effective than topical diltiazem in the treatment of CAF. Topical diltiazem may be employed as an initial conservative treatment option before considering the surgical alternative.

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Section: Discussionmentioning

confidence: 84%

Section: Introductionmentioning

confidence: 99%

Randomised Prospective Controlled Trial of Topical 2 % Diltiazem Versus Lateral Internal Sphincterotomy for the Treatment of Chronic Fissure in Ano

Vaithianathan

Panneerselvam²

2014

Indian J Surg

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“…Concluyendo que la esfinterotomia lateral interna abierta o cerrada parecen ser igual de eficaces. Considera además que la rigurosa medida de la esfinterotomia puede disminuir el riesgo de incontinencia 8 . …”

Section: Resultsunclassified

“…Para el grupo esfinterotomia a los 12 meses los porcentajes disminuyen hasta 4% en el mejor de los grupos, valor que es considerado elevado por los autores 8 .…”

Section: Discussionunclassified

Bottox O Esfinterotomia Para El Tratamiento De La Fisura Anal Crónica

Flores¹

2017

RFMH

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RESUMENObjetivos: Determinar cuál es el mejor tratamiento para fisura anal crónica en base a la evidencia existente. Diseño: Revisión bibliográfica con palabras clave "Fisura Anal Crónica", "Bottox" y "Esfinterotomia". Métodos: Se consultaron las bases de datos Medline, Pubmed, Cochrane, EMBASE. Se incluyeron revisiones sistemáticas, estudios prospectivos randomizados controlados y guías de manejo, del año 2000 al 2017. El porcentaje de curación e incontinencia fue evaluado a los 2 meses y 12 meses en el grupo de tratamiento con Bottox y con Esfinterotomia lateral interna. Resultados: Se seleccionaron 3 estudios prospectivos randomizados controlados, 2 revisiones sistemáticas y 1 guía de tratamiento. El porcentaje de curacion a los 12 meses se mantuvo sobre 92% en el grupo con esfinterotomia lateral interna y el máximo en el grupo Bottox fue 75.4%. El porcentaje de incontinencia a los 12 meses es variable en los trabajos revisados, pero disminuye en todos, variando desde 4 -16% en el grupo con esfinterotomia lateral interna y en el grupo Bottox fue 0%. Conclusión: La esfinterotomia lateral interna presenta mejores resultados de curacion a largo plazo y los porcentajes de incontinencia disminuyen a los 12 meses presentando mayor variación.Palabras clave: Fisura Anal Crónica; Bottox; Esfinterotomia. (fuente: DeCS BIREME) ABSTRACTObjectives: Determine what is the best treatment for chronic anal fissure based on existing evidence. Design: Bibliographic review with key words "Chronic Anal Fissure", "Bottox" and "Sphincterotomy". Methods: The databases Medline, Pubmed, Cochrane, EMBASE were consulted. Systematic reviews, controlled randomized prospective studies and management guidelines were included, from 2000 to 2017. The percentage of cure and incontinence was evaluated at 2 months and 12 months in the treatment group with Bottox and with internal lateral sphincterotomy. Results: Three randomized controlled prospective studies, 2 systematic reviews and 1 treatment guideline were selected. The percentage of cure at 12 months remained above 92% in the group with internal lateral sphincterotomy and the maximum in the Bottox group was 75.4%. The percentage of incontinence at 12 months is variable in the reviewed works, but decreases in all, varying from 4 -16% in the group with internal lateral sphincterotomy and in the Bottox group it was 0%. Conclusion: The internal lateral sphincterotomy shows better long-term healing results and the incontinence percentages decrease after 12 months, presenting greater variation.Key words: Chronic Anal Fissure; Bottox; Sphincterotomy. (source: MeSH NLM) ARTÍCULO ORIGINAL DOI 10.25176/RFMH.v17.n3.1191 Journal home page: http://revistas.urp.edu.pe/index.php/RFMH © Los autores. Este artículo es publicado por la Revista de la Facultad de Medicina Humana, Universidad Ricardo Palma. Este es un artículo de Open Access distribuido bajo los términos de la Licencia Creative Commons Atribución-NoComercial-CompartirIgual 4.0 Internacional.(http://creativecommons.org/licenses/by-nc-sa/4.0/),...

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“…the most recently published Cochrane reviews of therapy for anal fissure described 102 randomized trials. 2,3 in the current updates nearing completion, we will be adding more than 40 additional randomized trials. not a single one of those trials examined the efficacy of fissurectomy and botox in the treatment of anal fissure.…”

Section: Efficacy Of Fissurectomy and Botox For Chronic Anal Fissurementioning

confidence: 99%

The Author Replies

Barnes¹

2016

Diseases of the Colon &Amp; Rectum

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Operative procedures for fissure in ano

Cited by 84 publications

References 44 publications

Randomised Prospective Controlled Trial of Topical 2 % Diltiazem Versus Lateral Internal Sphincterotomy for the Treatment of Chronic Fissure in Ano

Randomised Prospective Controlled Trial of Topical 2 % Diltiazem Versus Lateral Internal Sphincterotomy for the Treatment of Chronic Fissure in Ano

Bottox O Esfinterotomia Para El Tratamiento De La Fisura Anal Crónica

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