Trends in Treatment for Hemorrhoids, Fistula, and Anal Fissure: Go Along the Current Trends

Abstract

Recent trends in benign anal disease treatment are minimizing surgery to preserve normal anorectal anatomical unit and its functions. However, some surgeons still prefer and are confident with the use of conventional solid surgical methods. In this report, we will investigate the recent trends in the treatment for hemorrhoids, fistula, and anal fissure. The practice guidelines of advanced countries, including UK, Italy, France, USA, Japan, and ESCP, are referred to in this review. Opinions suggested in international meetings were also added. In the management of hemorrhoids, surgical treatments and office procedures were recommended according to a patient's status and preference. For the management of complex anal fistula, novel sphincter-preserving surgical techniques are more widely accepted than a sphincter-dividing procedure of immediate repair following fistulectomy. The treatment of anal fissures is well covered in the guidelines of the ASCRS.

Comparative Efficacy of Topical Metronidazole and Glyceryl Trinitrate Versus Topical Glyceryl Trinitrate Alone in the Treatment of Acute Anal Fissure: A Randomized Clinical Trial

“…An anal fissure is a longitudinal, oval lesion in the anal canal. In over 90% of instances, the anal fissures are located posterior to the midline and produce discomfort upon defecation and/or bleeding owing to spasms of the internal anal sphincter (IAS) that leads to ischemia [2]. It is believed that the pathophysiology of anal fissures is connected to injury caused by passing hard faeces or persistent diarrhoea.…”

Bleeding Per Rectum: A Retrospective Study of 120 Cases

“…In the Western population, diverticular disease is the most common cause of bleeding, forming 40% of the cases followed by angiodysplasia and ischemic colitis (6,7,9,10). However, in the Middle East and Asia, the epidemiology of etiology of rectal bleeding differs from the West, the most common is benign anorectal causes; hemorrhoid followed by fissure is in the top of the list (11,12).…”

Surgical treatment of anal fistula

“…Лечение методом рассечения или иссечения свища в просвет кишки (фистулотомия, или фистулэктомия) является оптимальным технологическим методом лечения простых анальных свищей, захватывающих менее 30 % наружного сфинктера, и рекомендована как безопасная технология лечения клиническими рекомендациями Ассоциации колопроктологов России и Американского общества хирургов толстой и прямой кишки [34,35]. Правильное выполнение метода оперативного вмешательства минимизирует рецидив анального свища, а полное заживление раны обычно достигается в короткие сроки.…”