Patients with anal fistula due to chronic anal fissure: prevelance and treatment

Background: The association of an abscess and/or fistula with the fissure is not identification. Data on the treatment strategy is not clear and also indefinite.Methods: The aim of this study was to search for the prevalence of a fistula in patients with chronic anal fissure (CAF). All of the patients were examined by physicians specialized and experienced in proctology. They were registered on standardized forms. Patients who described discharge after chronic anal pain in their anamnesis also worked on these forms. All of the patients included in the study had a CAF and an anal fistula developed on the basis of anal fissure.Results: Patients who underwent surgery for anal fistula between 2011-2020 were analyzed rectospectively. Nineteen patients (2.6%) had a fistula due to CAF. Twelve (62%) of the patients had superficial fistula, 7 (38%) had type 1 fistula. Fistulectomy and internal sphincterotomy were performed in patients with superficial fistula developed on the basis of CAF. In patients with type 1 anal fistula developed on the background of CAF, only fistulotomy was performed. The mean recovery time of the patients was 14 days and the mean duration of symptoms was 4 days.Conclusions: It is the determinant of CAF in the success of the treatment of anal fistula developing on the basis of CAF. Adequate sphincterotomy is successful in the treatment of CAF and anal fistula developing on the fissure background.

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Clinical Outcomes of Lateral Internal Sphincterotomy for Patients with Chronic Anal Fissure

Journal of the Korean Society of Coloproctology ◽

10.3393/jksc.2007.23.5.292 ◽

2007 ◽

Vol 23 (5) ◽

pp. 292

Author(s):

Jung Soo Park ◽

Jae Bum Lee ◽

Tae Sun Kim ◽

Hang Jun Cho ◽

Do Sun Kim ◽

...

Keyword(s):

Clinical Outcomes ◽

Anal Fissure ◽

Chronic Anal Fissure ◽

Lateral Internal Sphincterotomy ◽

Internal Sphincterotomy

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Calibrated lateral internal sphincterotomy for chronic anal fissure

Techniques in Coloproctology ◽

10.1007/s10151-005-0210-9 ◽

2005 ◽

Vol 9 (2) ◽

pp. 127-132 ◽

Cited By ~ 23

Author(s):

G. Rosa ◽

P. Lolli ◽

D. Piccinelli ◽

F. Mazzola ◽

C. Zugni ◽

...

Keyword(s):

Anal Fissure ◽

Chronic Anal Fissure ◽

Lateral Internal Sphincterotomy ◽

Internal Sphincterotomy

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Stellungnahme zum Kommentar von B. Strittmatter zu P.J. Gupta et al. Closed Lateral Internal Sphincterotomy Versus Anal Sphincterolysis for Chronic Anal Fissure. A Prospective, Randomized, Controlled Trial

coloproctology ◽

10.1007/s00053-008-8044-3 ◽

2008 ◽

Vol 30 (6) ◽

pp. 417-417

Author(s):

Pravin J. Gupta

Keyword(s):

Randomized Controlled Trial ◽

Anal Fissure ◽

Chronic Anal Fissure ◽

Controlled Trial ◽

Lateral Internal Sphincterotomy ◽

Internal Sphincterotomy ◽

Randomized Controlled ◽

Prospective Randomized Controlled Trial

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Botulinum Toxin Injection Versus Lateral Internal Sphincterotomy in the Treatment of Chronic Anal Fissure: A Randomized Controlled Trial

World Journal of Surgery ◽

10.1007/s00268-010-0736-5 ◽

2010 ◽

Vol 34 (11) ◽

pp. 2730-2734 ◽

Cited By ~ 28

Author(s):

Maged Nasr ◽

Hussin Ezzat ◽

Magdy Elsebae

Keyword(s):

Randomized Controlled Trial ◽

Botulinum Toxin ◽

Anal Fissure ◽

Chronic Anal Fissure ◽

Controlled Trial ◽

Botulinum Toxin Injection ◽

Lateral Internal Sphincterotomy ◽

Internal Sphincterotomy ◽

Randomized Controlled

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Closed lateral Internal Sphincterotomy under local anesthesia in OPD in the treatment of chronic Anal Fissure

Annals of King Edward Medical University ◽

10.21649/akemu.v10i1.1133 ◽

2016 ◽

Vol 10 (1) ◽

Author(s):

Naved Ahmad ◽

Muzaffar Aziz ◽

Faizullah .

Keyword(s):

Postoperative Complications ◽

Anal Fissure ◽

Local Anesthesia ◽

Local Anaesthesia ◽

Chronic Anal Fissure ◽

Dentate Line ◽

Lateral Internal Sphincterotomy ◽

Internal Sphincterotomy ◽

Operative Complications

Objective of this study is to provide best therapy in terms of hospital stay and post operative complications after closed lateral internal sphincterotomy under local anaesthesia in the treatment of chronic anal fissure. It is descriptive type of study carried out at Nishtar Hospital Multan, from February 2001 to April 2001. Thirty patients underwent closed lateral internal sphicterotomy in local anaesthesia in OPD. Internal anal sphincter divided up to dentate line by introducing no.11 surgical blade in the intersphicteric groove. Pts were allowed to go home just after the surgery. Follow up for complications was done for the period of 6months. Mean postoperative stay was for 12 minutes. Postoperative complications were soiling (6.6%), incontinence to flatus (3.3%) and recurrence (3.3%). CLIS can be done safely under local anesthesia in OPD with low complication rate and less postop period of stay.

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Ketoacidosis in new-onset type 1 diabetes: did the severity increase during the COVID-19 pandemic?

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem-2021-0449 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Teresa A. Botelho ◽

Joana M. N. Santos ◽

Crisbety M. S. Pinho ◽

Ana Isabel B. R. Martins ◽

Adriana I. S. Formiga ◽

...

Keyword(s):

Weight Loss ◽

Type 1 Diabetes ◽

Relative Risk ◽

Glycated Haemoglobin ◽

Treatment Delay ◽

Duration Of Symptoms ◽

The Mean ◽

Mean Differences ◽

New Onset

Abstract Objectives Since the beginning of the COVID-19 pandemic, there has been a consistent decrease in the number of admissions to the emergency department, leading to a delay in the diagnosis of several pathologies. The time from onset of symptoms to the diagnosis of Type 1 diabetes is highly variable. This treatment delay can lead to the appearance of ketoacidosis. Methods Retrospective study of inaugural Type 1 diabetes cases, from March 2016 to March 2021. The pandemic group was considered between March 2020 to March 2021, and the remaining period was considered as pre-pandemic. Clinical variables were analysed: duration of symptoms, weight loss and value of ketonemia and glycated haemoglobin on admission. The mean differences were considered statistically significant at p<0.05. Results 103 inaugural episodes of Type 1 diabetes were registered. The pandemic group had a lower mean age when compared to pre-pandemic group, and 51.7% of the episodes had ketoacidosis with a higher relative risk of ketoacidosis and severe ketoacidosis, when compared the pandemic with pre-pandemic group, there was a longer symptom evolution time (34 vs. 20 days), greater weight loss occurred (9.5% vs. 6.3%), the pH and HCO3 − values were lower (7.30 vs. 7.36 and 16.43 vs. 20.71 mmol/L respectively) and ketonemia was higher (5.9 vs. 2.3 mmol/L). Conclusions The COVID-19 pandemic caused a delay in the diagnosis of Type 1 diabetes, greater length of disease, greater weight loss, higher ketonemia and lower pH and HCO3 −. There was greater ketoacidosis relative risk in pandemic group when compared to pre-pandemic group.

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A Comparison between the Results of Open versus Closed Lateral Internal Sphincterotomy in the Surgical Management of Chronic Anal Fissure

BIRDEM Medical Journal ◽

10.3329/birdem.v8i3.38130 ◽

2018 ◽

Vol 8 (3) ◽

pp. 235-239

Author(s):

Md Mahabub ◽

Md Mahbubur Rahman ◽

Md Tanvirul Islam ◽

Selina Sultana

Keyword(s):

Anal Fissure ◽

Chronic Anal Fissure ◽

Lateral Internal Sphincterotomy ◽

Complication Rates ◽

Open Technique ◽

Female Ratio ◽

Internal Sphincterotomy ◽

Closed Technique ◽

Increased Risk ◽

Open Versus

Background: Lateral internal sphincterotomy is regarded as the gold standard surgical treatment for chronic anal fissure. Some authors reported that the closed technique had lower complication rates than that by the open technique, but others reported that both of the techniques had no meaningful differences in complications.Methods: This was a comparative and cohort study carried out at Department of Colorectal Surgery, Combined Military Hospital (CMH) Dhaka, Bangladesh, from October 2013 to October 2017. Eighty three patients with chronic anal fissure not responding to medical treatment for at least three months were included in this study to compare the results of the open versus closed techniques of lateral internal sphincterotomy after four months follow up postoperatively.Results: The mean age at presentation was 34.15±11.4 years and the male to female ratio was 1.24:1. The results of open and closed techniques were compared regarding per-operative bleeding (35.71% versus 12.19%), post-operative urinary retention (4.76% versus 0%), symptom relief on first post-operative day (76.19% versus 70.73%), significant 1st post-operative day pain in the operated wound (33.33% versus 7.31%), temporary fecal soiling (2.38% versus 0%), temporary flatus incontinence (7.14% versus 0%), and fissure recurrence (0% versus 14.63%) respectively. Temporary incontinence to fecal and flatus recovered by conservative management within two and four months of surgery respectively.Conclusion: The closed technique of lateral internal sphincterotomy had lower post-operative complications, pain, bleeding, and incontinence compared to open technique, but increased risk of fissure recurrence.Birdem Med J 2018; 8(3): 235-239

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Botulinum Toxin A with Fissurectomy is a Viable Alternative to Lateral Internal Sphincterotomy for Chronic Anal Fissure

The American Surgeon ◽

10.1177/000313480907501013 ◽

2009 ◽

Vol 75 (10) ◽

pp. 925-928 ◽

Cited By ~ 4

Author(s):

Ohara Aivaz ◽

Jessica Rayhanabad ◽

Vincent Nguyen ◽

Philip I. Haigh ◽

Maher Abbas

Keyword(s):

Botulinum Toxin ◽

Fecal Incontinence ◽

Anal Fissure ◽

Chronic Anal Fissure ◽

Botulinum Toxin A ◽

Internal Sphincter ◽

Viable Alternative ◽

Lateral Internal Sphincterotomy ◽

Toxin A ◽

Internal Sphincterotomy

Lateral internal sphincterotomy (LIS) is the gold standard surgical treatment for anal fissure. However, it carries potential complications, including fecal incontinence. The goal of this retrospective study was to compare the outcome of botulinum toxin A injection coupled with fissurectomy ([BTX + FIS) versus LIS. There were 59 patients who underwent BTX + FIS or LIS over a 5-year period. LIS was performed in the standard fashion without fissurectomy. BTX + FIS entailed internal sphincter injection with 80 units of botulinum toxin A coupled with fissurectomy. Forty patients underwent LIS and 19 had BTX + FIS. The choice of operation was based on the patient's preference. Primary healing rate was 90 and 74 per cent in the LIS and BTX + FIS groups, respectively ( P = 0.13). The complication rate was 10 per cent in the LIS vs 0 per cent in the BTX + FIS groups ( P = 0.29). Complications of LIS included anal sepsis in one patient and flatal and/or fecal incontinence in three patients. During a mean follow up of 19 months; recurrence rate was 0 and 5 per cent in the LIS and BTX+FIS groups, respectively ( P = 0.32). The results of this study demonstrate that BTX + FIS is a viable alternative to LIS for patients with chronic anal fissure and should be considered as an alternative first-line surgical therapy.

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Fissurectomy combined with botulinum toxin A: a review of short- and long-term efficacy of this treatment strategy for chronic anal fissure; a consecutive proposal of a treatment algorithm for chronic anal fissure

coloproctology ◽

10.1007/s00053-020-00480-7 ◽

2020 ◽

Vol 42 (5) ◽

pp. 400-408

Author(s):

M. Trzpis ◽

J. M. Klaase ◽

R. H. Koop ◽

P. M. A. Broens

Keyword(s):

Botulinum Toxin ◽

Anal Fissure ◽

Recurrence Rate ◽

Treatment Strategy ◽

Chronic Anal Fissure ◽

Botulinum Toxin A ◽

Toxin A ◽

Term Efficacy ◽

Short And Long Term

Abstract Background Several studies have investigated the short- and long-term efficacy of fissurectomy combined with botulinum toxin A injection for patients with chronic anal fissure. Objective To evaluate the short- and long-term efficacy of the combined treatment strategy of fissurectomy with botulinum toxin A for chronic anal fissure and to discuss recurrence rates in the light of current theory on the aetiology of anal fissure. Materials and methods This is a narrative review. We conducted an article search using PubMed and calculated the means of the reported efficacy ranges. Results Fissurectomy combined with botulinum toxin A injections freed at least 78% of the patients from symptoms and yielded a fissure healing rate of up to 86%. Within 12 months after treatment a 3% recurrence rate was reported. On average, the long-term recurrence rate was 22%. One study reported a 50% recurrence rate 22 months after treatment. Conclusion The efficacy of fissurectomy combined with botulinum toxin A injection for chronic anal fissure is high. The short-term recurrence rate is low, while long-term recurrence is relatively high. Extended follow-up indicates that recurrence of chronic anal fissure is possibly caused by anal basal pressure building up steadily once again. If so, the cause of renewed increase of pressure should be addressed. Based on the literature and on our clinical experience, we assume that the underlying cause of increasing anal basal pressure is that patients use their pelvic floor muscles inadequately and this in turn leads to chronic anal fissure.

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