The role of percutaneous tibial nerve stimulation (PTNS) in the treatment of chronic anal fissure: a systematic review

Perivoliotis, Konstantinos; Baloyiannis, Ioannis; Ragias, Dimitrios; Beis, Nikolaos; Papageorgouli, Despoina; Xydias, Emmanouil; Tepetes, Konstantinos

doi:10.1007/s00384-021-03976-w

Cited by 10 publications

(4 citation statements)

References 55 publications

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“…In their review from 2021, Perivoliotis et al. [75] found five studies including 102 chronic anal fissure patients treated with PTNS. A total of 74% of patients were symptom free at 6 months.…”

Section: Resultsmentioning

confidence: 99%

“…Several studies have assessed percutaneous tibial nerve stimulation (PTNS) in the management of chronic anal fissures. In their review from 2021, Perivoliotis et al [75] found five studies including 102 chronic anal fissure patients treated with PTNS. A total of 74% of patients were symptom free at 6 months.…”

Section: Grade Of Evidence: Very Lowmentioning

confidence: 99%

“…The pooled recurrence rate of anal fissure was 19%. Post treatment pain was significantly reduced [75]. However, there was a high degree of heterogeneity and bias and the review itself is considered as having a high risk of bias (see Appendix 4).…”

Section: Grade Of Evidence: Very Lowmentioning

confidence: 99%

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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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Section: Resultsmentioning

confidence: 99%

Section: Grade Of Evidence: Very Lowmentioning

confidence: 99%

See 1 more Smart Citation

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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show abstract

“…A systematic review of 5 studies including 102 patients, estimated a pooled recurrence rate of 19% (16/84) with considerably reduced post-interventional pain scores, a 2-month healing rate of 72% (18/25) and 73.6% of patients symptom-free at 6 months [ 140 ]. However, the evaluated studies showed considerable limitations related to the small sample size, short-term follow-up, study design and heterogeneity in the neuromodulation technique and setting.…”

Section: Questions and Statementsmentioning

confidence: 99%

The Italian Unitary Society of Colon-proctology (SIUCP: Società Italiana Unitaria di Colonproctologia) guidelines for the management of anal fissure

Brillantino,

Renzi,

Talento

et al. 2023

BMC Surg

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Introduction The aim of these evidence-based guidelines is to present a consensus position from members of the Italian Unitary Society of Colon-Proctology (SIUCP: Società Italiana Unitaria di Colon-Proctologia) on the diagnosis and management of anal fissure, with the purpose to guide every physician in the choice of the best treatment option, according with the available literature. Methods A panel of experts was designed and charged by the Board of the SIUCP to develop key-questions on the main topics covering the management of anal fissure and to performe an accurate search on each topic in different databanks, in order to provide evidence-based answers to the questions and to summarize them in statements. All the clinical questions were discussed by the expert panel in different rounds through the Delphi approach and, for each statement, a consensus among the experts was reached. The questions were created according to the PICO criteria, and the statements developed adopting the GRADE methodology. Conclusions In patients with acute anal fissure the medical therapy with dietary and behavioral norms is indicated. In the chronic phase of disease, the conservative treatment with topical 0.3% nifedipine plus 1.5% lidocaine or nitrates may represent the first-line therapy, eventually associated with ointments with film-forming, anti-inflammatory and healing properties such as Propionibacterium extract gel. In case of first-line treatment failure, the surgical strategy (internal sphincterotomy or fissurectomy with flap), may be guided by the clinical findings, eventually supported by endoanal ultrasound and anal manometry.

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Pelvic floor dysfunction and chronic anal fissure: a dog chasing its tail

2022

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The role of percutaneous tibial nerve stimulation (PTNS) in the treatment of chronic anal fissure: a systematic review

Cited by 10 publications

References 55 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

The Italian Unitary Society of Colon-proctology (SIUCP: Società Italiana Unitaria di Colonproctologia) guidelines for the management of anal fissure

Pelvic floor dysfunction and chronic anal fissure: a dog chasing its tail

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