scholarly journals LATERAL INTERNAL SPHINCTEROTOMY

2009 ◽  
Vol 16 (01) ◽  
pp. 24-28
Author(s):  
MUHAMMAD SAJID ◽  
MUHAMMAD AFZAL
Keyword(s):  
Anal Fissure ◽  
Chronic Anal Fissure ◽  
Sphincter Muscle ◽  
Anal Abscess ◽  
Fistula In Ano ◽  
Anal Sphincter Muscle ◽  
Anterior Midline ◽  
Delayed Healing ◽  
Posterior Midline

Anal fissure is a common anorectal problem, presenting with pain during and after defecation. It is associated withincreased tone of the internal anal sphincter muscle. The relief of this hypertonia is the cornerstone of the treatment of the anal fissure. Thesurgical relief of this hypertonia is very successful in treating the fissure with minor morbidity of the procedure. Patients & M e t h o d s : A studywas conducted in 486 patients,(344-males and 142 females,25-40 range). Setting: Saad Surgi-med hospital Faisalabad. Period: 1999to 2007. Lateral internal anal Sphincterotomy for chronic anal fissure. The therapeutic outcome and complications of the procedure wererecorded. Results: Out of 486 patients, 344 were males and 142 females.frange 25-40) The site of fissure was in posterior midline 6 O' clockin 350 patients.(m=257,f=93);Anterior midline. 12 O'clock in 99 patients.(m=76,f=23);both anterior and posterior in 41 patients.(m=l 5,f=26)Eleven patients had associated peri-anal abscess and 19 patients had associated Fistula in ano. All the patients were discharged after 24hrs with regular follow up at 1,2,6,24 wks. 275 patients had significant relief of pain in 48 hrs, 107 became pain free in 1 wk.37 has had somepain for 2 wks. In 479 patients fissure healed in 3 months, 7 patients has had delayed healing out of which five patients required curettageof the wound under local anaesthesia which healed subsequently in next six wks. 12 patients had minor incontinence whichdisappeared in 4 wks. In one patient the incontinence persisted for six months then it got settled. Conclusion: Lateral subcutaneous internalSphincterotomy is a safe and effective treatment of chronic anal fissure.

scholarly journals ANAL FISSURE;

2012 ◽  
Vol 19 (06) ◽  
pp. 760-763
Author(s):  
SHAUKAT ALI ◽  
MUHAMMAD AZIM KHAN ◽  
SHAHID MANSOOR NIZAMI
Keyword(s):  
Anal Fissure ◽  
Chronic Anal Fissure ◽  
Age Group ◽  
Female Patients ◽  
Non Invasive ◽  
Chemical Sphincterotomy ◽  
Anterior Midline ◽  
Study Results ◽  
Posterior Midline

Objective: To know the outcome of treatment of chronic anal fissure. Setting: Nishtar Hospital, Multan. Period: January 2011 toJune 2011. Material and methods: A total of 100 patients attending surgical OPD were included in the study. Results: Out of 100 patients, 73(73%) were male and 27 (27%) were female patients. Majority of the patients were from the age group 31-40 years. At posterior midline fissurein ano was present in 91 (91%) patients and at the anterior midline it was in 9 (9%). Pain defecation was seen in all patients, constipation in 95(95%) patients whereas bleeding from rectum in 72 (72%) patients. Conclusions: It is concluded that in patients with chronic anal fissure,chemical sphincterotomy with topical nifedipine ointment is a non-invasive and effective modality.

scholarly journals Topical Diltiazem Versus Topical Glyceryl Trinitrate In The Management Of Chronic Anal Fissure

JMS SKIMS ◽  
2014 ◽  
Vol 17 (2) ◽  
pp. 55-58
Author(s):  
Shams Ul Bari ◽  
Ajaz Ahmad Malik ◽  
Khurshid Alam Wani ◽  
Ajaz A Rather
Keyword(s):  
Side Effects ◽  
Anal Fissure ◽  
Chronic Anal Fissure ◽  
P Value ◽  
Double Blind ◽  
Surgical Methods ◽  
Significant Difference ◽  
Topical Glyceryl Trinitrate ◽  
One Year

Background: Chemical sphincterotomy is a novel way for treating patients of chronic anal fissure which avoids the risk of fecal incontinence associated with traditional surgical methods. Aims and objectives: The aim of this study was to compare the results of topical Diltiazem with topical Glyceril trinitrate in the management of chronic anal fissure. Methods: 71 patients in the age group of 15 - 61 years with chronic anal fissure were included in this prospective, randomized, double-blind trial over a period of two years with further follow up for one year. The patients were randomly allocated to either Diltiazem gel 2% (37 patients) or Glyceril trinitrate ointment 0.2% (34 patients) and were asked to use the treatment twice daily for 8 weeks. Each patient was reviewed every two weeks. Symptoms, healing, side effects and recurrence were compared using SPSS version 10 employing X2 test. A p-value below 0.05 was considered statistically significant. Results: Patients who received topical diltiazem (DTZ) showed statistically significant difference than those who were prescribed topical glyceril trinitrate in terms of symptoms, wound healing, side effects ( headaches) and recurrence (p=0.03 and 0.003 respectively). Healing occurred in 34 of 37 (92%) patients treated with Diltiazem after 6 weeks and 27 of 34 (80%) patients treated with Glyceril trinitrate after 8 weeks, which shows a significant difference in favour of Diltiazem (P < 0.001). The rest of the patients did not heal and underwent sphincterotomy (SILS). Headache occurred in all of the patients treated with Glyceril trinitrate but none of the patients treated with Diltiazem. Conclusion: Diltiazem gel was found to be better than Glyceril trinitrate ointment due to significantly higher healing rate and fewer side-effects. JMS 2014;17(2):55-58

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

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.

scholarly journals Safety and effectiveness of saving sphincter procedure in the treatment of chronic anal fissure in female patients

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Beatrice D’Orazio ◽  
Girolamo Geraci ◽  
Sebastiano Bonventre ◽  
Dario Calì ◽  
Gaetano Di Vita
Keyword(s):  
Anal Fissure ◽  
De Novo ◽  
Chronic Anal Fissure ◽  
Complete Healing ◽  
Low Grade ◽  
Normal Range ◽  
Female Patients ◽  
Functional Differences ◽  
Cutaneous Flap

Abstract Introduction Lateral internal sphincterotomy (LIS) is still the approach of choice for the treatment of chronic anal fissure (CAF) regardless to the internal anal sphincter tone but it is burdened by high risk post-operative faecal incontinence (FI). In female patient there are some anatomical and functional differences of the sphinteric system which make them more at risk of FI and vaginal birth could cause sphinteric lesions affecting the anal continence function. The aim of our study is to evaluate the results of saving sphincter procedure as treatment for female patients affected by CAF. Methods We studied 110 female patients affected by CAF undergone fissurectomy and anoplasty with V–Y cutaneous flap advancement associating pharmacological sphincterotomy in patients with hypertonic IAS. The follow up was at least for 2 years. The goals were patient’s complete healing, the evaluation of FI, recurrence rate and manometry parameters. Results All wounds healed within 40 days after surgery. We recorded 8 cases of recurrences 6 healed with medical therapy and 2 with dilatation. We recorded 2 “de novo” temporary and low grade post-operative cases of FI. Post-operative value of MRP were unmodified in patient with normotonic IAS but significantly lower at 12 months follow up as compared with the pre-operative ones in patients with hypertonic IAS; after 24 months from surgery MRP values were within the normal range. Conclusion The fissurectomy and anoplasty with V–Y cutaneous flap alone or in association with a pharmacological sphincterotomy in patients with hypertonic IAS may represent an effective approach for the treatment of CAF in female patients.

Topical 0.5% nifedipine vs. lateral internal sphincterotomy for the treatment of chronic anal fissure: long-term follow-up

2005 ◽  
Vol 21 (2) ◽  
pp. 179-183 ◽  
Author(s):  
Panagiotis Katsinelos ◽  
Basilios Papaziogas ◽  
Ioannis Koutelidakis ◽  
George Paroutoglou ◽  
Stavros Dimiropoulos ◽  
...  
Keyword(s):  
Anal Fissure ◽  
Chronic Anal Fissure ◽  
Lateral Internal Sphincterotomy ◽  
Internal Sphincterotomy ◽  
Long Term Follow Up

scholarly journals Long‐term outcomes of Botulinum toxin in the treatment of chronic anal fissure: 5 years of follow‐up

2017 ◽  
Vol 5 (2) ◽  
pp. 293-297 ◽  
Author(s):  
Sandra Barbeiro ◽  
Catarina Atalaia‐Martins ◽  
Pedro Marcos ◽  
Cláudia Gonçalves ◽  
Manuela Canhoto ◽  
...  
Keyword(s):  
Botulinum Toxin ◽  
Anal Fissure ◽  
Chronic Anal Fissure ◽  
Long Term Outcomes

scholarly journals Myoxinol (HydrolyzedHibiscus esculentusExtract) in the Cure of Chronic Anal Fissure: Early Clinical and Functional Outcomes

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Adolfo Renzi ◽  
Antonio Brillantino ◽  
Giandomenico Di Sarno ◽  
Francesco D’Aniello ◽  
Stefania Ziccardi ◽  
...  
Keyword(s):  
Anal Fissure ◽  
Topical Application ◽  
Chronic Anal Fissure ◽  
Early Results ◽  
Local Product ◽  
Resting Pressure ◽  
Hibiscus Esculentus ◽  
Anal Resting Pressure ◽  
Lost To Follow Up

Objective.This study was designed to evaluate the early results of the topical application of HydrolyzedHibiscus esculentusExtract 3% ointment (Myoxinol 3%), a novel local product with Botox-like activity, in the conservative treatment of chronic anal fissure (CAF).Methods.Among all patients with CAF observed during the study period, 31 subjects met the inclusion criteria and underwent medical therapy with Myoxinol 3% ointment every 12 hours for 6 weeks. Two patients were lost to follow-up. Clinical and manometric follow-up was carried out eight weeks after treatment.Results.At follow-up the success rate was 72.4% (21/29); median VAS score and mean anal resting pressure were significantly lower if compared with respective baseline data. The only one adverse effect of the topical application of Myoxinol 3% ointment was perianal itch, which was reported by 3,4% (1/29) of the patients available for the analysis. However, in this case this symptom did not cause interruption of the treatment.Conclusions.The topical application of Myoxinol 3% ointment in the cure of CAF shows encouraging early results. Further researches with a larger series and a longer follow-up are needed to confirm these data.

scholarly journals Scanner-Assisted CO2 Laser Fissurectomy: A Pilot Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Giani Iacopo ◽  
Cioppa Tommaso ◽  
Linari Chiara ◽  
Caminati Filippo ◽  
Dreoni Paolo ◽  
...  
Keyword(s):  
Anal Fissure ◽  
Pain Control ◽  
Thermal Damage ◽  
Chronic Anal Fissure ◽  
Complete Healing ◽  
High Rate ◽  
Exclusion Criteria ◽  
Internal Sphincterotomy ◽  
Maximum Pain

Introduction: Surgery for chronic anal fissure is challenging for every proctologist. Solving the pain by guaranteeing rapid and effective healing is the objective, but what is the price to pay today in functional terms? Though this result is nowadays partially achievable through interventions that include the execution of an internal sphincterotomy among the procedures, it is necessary to underline the high rate of patients who can present faecal incontinence. The aim of this study is to explore the effectiveness of scanner-assisted CO2 laser fissurectomy.Methods: From April 2021 to September 2021, all consecutive patients who affected by chronic anal fissure suitable for surgery, meeting the inclusion and exclusion criteria, were evaluated. All planned data were recorded before surgery, then at 24 h, 1 week, and 1 month follow-up. A scanner-assisted CO2 laser was used in this study to achieve a smooth and dried wound with a minimal tissue thermal damage, to ensure good postsurgical pain control, rapid and functional, elastic and stable healing, and to prevent potential relapses. Paracetamol 1 g every 8 h was prescribed for the first 24 h and then continued according to each patient's need. Ketorolac 15 mg was prescribed as rescue.Results: Mean pain intensity ≤3, considered as the principal endpoint, was recorded in 26 out of the 29 patients who enrolled in the study with a final success rate of 89.7% at 1-month follow-up. Pain and anal itching showed a statistically significant reduction while bleeding, burning, and maximum pain, and REALIS score showed a reduction too at the end of the follow-up period. Reepithelisation proved to be extremely fast and effective: 22 of 29 (75.9%) showed a complete healing and 5 showed a partial reepithelisation at 1-month follow-up.Discussion: Outcomes of this study showed that it is undoubtedly necessary to change the surgical approach in case of anal fissure. The internal sphincterotomy procedure must be most of all questioned, where the availability of cutting-edge technological tools must be avoided and offered only in selected cases. Scanner-assisted CO2 laser showed great results in terms of pain control and wound healing, secondary to an extremely precise ablation, vaporisation, and debridement procedures with minimal lateral thermal damage.

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