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.

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 Prospective Randomized Study between Open Vs Closed Lateral Anal Internal Sphincterotomy in Patients with Chronic Fissure in Ano

2020 ◽  
Vol 3 (1) ◽  
pp. 167-171
Author(s):  
Anand Shanmugaiah ◽  
Saravanan Pandian
Keyword(s):  
Anal Fissure ◽  
Chronic Anal Fissure ◽  
Randomized Study ◽  
Fissure In Ano ◽  
Internal Sphincterotomy ◽  
Post Surgery ◽  
Significant Difference ◽  
Group A ◽  
Group B

Background: One of the the most common cause of pain during defecationin young patientsis chronic fissure in ano. Surgical treatment of choice for chronic fissure in ano is internal sphincterotomy. This procedure can be performed by open or closed method. The aim of the study was to compare the closed and open anal internal sphincterotomy in patients admitted in our hospital with chronic anal fissure. Subjects and Methods: 105 patients admitted in department of general surgery with chronic fissure in ano were divided into two groups. 50 patients (Group A) who were treated by closed method and 55 patients (Group B) who were managed by open lateralanal sphincterotomy method. A 3 months follow up done in both post-surgery to observe for pain, bleeding, infection, incontinence, and recurrence. Results: Significant difference was observed in postoperative acute complications between the two methods of internal anal sphincterotomy. Conclusion: Lateral anal sphincterotomy is the treatment of choice for chronic anal fissure, either open or closed method. However, the closed method was observed to have lesserpost operative complication compared to the open method.

scholarly journals Comparative study of lateral Internal Sphincterotomy verses Topical Glyceryl Trinitrate for treatment of fissure-in-Ano

2016 ◽  
Vol 9 (4) ◽  
Author(s):  
Ajmal Farooq ◽  
Zahid Niaz
Keyword(s):  
Anal Fissure ◽  
Chronic Anal Fissure ◽  
Symptomatic Improvement ◽  
Lateral Internal Sphincterotomy ◽  
Fissure In Ano ◽  
Internal Sphincterotomy ◽  
Group A ◽  
Topical Glyceryl Trinitrate ◽  
Group B

This prospective randomized interventional study was carried in one of surgical unit of Lahore General Hospital Lahore from 1st January 2002 to 30, December 2002 a total number of 100 patients with both acute and chronic anal fissure were taken and randomly divided in two groups. Group A was treated with 0.2% GTN for 6 weeks and Group B was treated with lateral internal closed Sphincterotomy a follow up after 0, 2nd, 61h weeks and even after 6 months carried out. Peak incidence of disease was observed between 30 and 40 years of age with 56 males and 44 females. 24% patients were with acute fissure and 76% with chronic fissure. In this study with 0.2% GTN overall healing rate of 66.66% for acute fissure and 63.15% for chronic anal fissure was observed. GTN was found less effective in healing the fissure but some what good for initial symptomatic improvement in its comparison 100% healing was observed with lateral internal sphincterotomy with only 10% transient incontinence for flatus. So it was concluded that lateral internal sphincterotomy is superior to GTN and is the procedure of choice for fissure in ano.

scholarly journals Comparative evaluation of fissurectomy versus lateral internal sphincterotomy in the treatment of chronic anal fissure

2018 ◽  
Vol 5 (4) ◽  
pp. 1407
Author(s):  
A. R. Bansal ◽  
Pradeep Yadav ◽  
Suvendu Jena ◽  
Sanjeev Kumar
Keyword(s):  
Side Effects ◽  
Pain Relief ◽  
Anal Fissure ◽  
Comparative Evaluation ◽  
Chronic Anal Fissure ◽  
Symptomatic Relief ◽  
Age Groups ◽  
Complete Healing ◽  
Lateral Internal Sphincterotomy ◽  
Internal Sphincterotomy

Background: Anal fissure is a common anorectal condition that affecting all age groups, but it is seen in young and healthy adults with equal incidence across both the sexes. The objective of this study was to evaluate and prospectively compare fissurectomy versus lateral internal sphincterotomy in the treatment of chronic anal fissure in terms of symptomatic relief, healing, recurrence and incontinence, if any.Methods: 50 patients with chronic anal fissure were alternately divided in two groups. In one group fissurectomy was done and in another group, patients underwent lateral internal sphincterotomy and comparative evaluation was done.Results: Complete healing was observed in 92% patients in fissurectomy group and 96% patients in lateral internal sphincterotomy group at the end of 6 weeks. Fissurectomy group patients reported early cut through of sutures and infection whereas in lateral internal sphincterotomy group two patients developed perianal hematoma at 3 months of follow up.Conclusions: While considering surgical management for treating chronic anal fissure, fissurectomy is comparable to lateral internal sphincterotomy in terms of symptomatic pain relief, healing rates with minimal side effects and low recurrence.

scholarly journals Results of tailored lateral sphincterotomy for chronic fissure in-ano

2019 ◽  
Vol 6 (11) ◽  
pp. 3947
Author(s):  
Ahemadi Firdous Nikhat ◽  
Mohd Zaheeruddin Ather
Keyword(s):  
Anal Fissure ◽  
Gold Standard ◽  
Chronic Anal Fissure ◽  
Internal Sphincter ◽  
Treatment Options ◽  
Lateral Internal Sphincterotomy ◽  
Fissure In Ano ◽  
Lateral Sphincterotomy ◽  
Internal Sphincterotomy

Background: Fissure-in-ano is one of the common and most painful anorectal conditions encountered in surgical practice. Inspite of several conservative treatment options, surgical treatment in the form of lateral anal sphincterotomy remains the gold standard of treatment for chronic anal fissure, however it is associated with the significant rate of incontinence. This study reviews using a tailored lateral sphincterotomy by selecting the height of internal sphincter to be divided with aim of preserving more sphincter and hence reducing the incontinence rates.Methods: The study was carried out in 50 patients who were diagnosed clinically as chronic anal fissure attending Surgery department of ESIC medical college and hospital, Kalburagi over a period of 6 months from January 2019 to August 2019. Tailored left lateral internal sphincterotomy was performed in all patients. The date was recorded and analysed. Early post-operative follow-up was maintained every week for four weeks or till the fissure healed. Complications mainly incontinence rate was assessed.Results: Common age group was third and fourth decade of life. Pain (100%) was the commonest symptom. Majority of the patients (96%) had posterior fissure. Postoperatively about 97% patients had complete pain relief. Only one patient (2%) in the study reported incontinence to flatus during the first follow-up visit and had minor incontinence and other minimal complications were found.Conclusions: Tailored lateral anal internal sphincterotomy is safe and effective surgical procedure for the management for chronic anal fissure with lower rate of incontinence rate compared to gold standard lateral internal sphincterotomy.

scholarly journals Anal fissures: Open lateral internal sphincterotomy results

2015 ◽  
Vol 2 (1) ◽  
pp. 87
Author(s):  
Abdul-Wahid M Salih
Keyword(s):  
Anal Fissure ◽  
Medical Records ◽  
Recurrent Disease ◽  
Chronic Anal Fissure ◽  
Lateral Internal Sphincterotomy ◽  
Internal Sphincterotomy ◽  
Good Patient ◽  
Patients Satisfaction ◽  
Good Patient Satisfaction

Background: Lateral Internal Sphincterotomy is the procedure of choice for chronic anal fissure because it relieves symptoms andheals the fissure in nearly all patients. However, data on its postoperative complications are limited particularly fecal incontinence.Therefore, the aim of this study is to investigate the results of this procedure in terms of recurrence rate, complications and patientsatisfaction.Methods: The medical records of 80 patients from 4 centers were collected during 20 months and evaluated retrospectively.Results: Incontinence was observed in 2 (2.5%) patients. The patients were discharged at the same day of the operation. Duringthe average follow-up of 24 months, two patients (2.5%) developed recurrent disease. In addition, patients’ satisfaction was high(95%).Conclusions: Lateral internal sphincterotomy is the procedure of choice for chronic anal fissure because it relieves symptomsand heals the fissure in nearly all patients with very low rate of complications, negligible recurrence and good patient satisfaction.

scholarly journals Effectiveness of 0.2% Glyceryl trinitrate and 0.5% Nifedipine in the Treatment of Chronic Anal Fissure

2017 ◽  
Vol 56 (205) ◽  
pp. 149-152 ◽  
Author(s):  
Suman Kumar Shrestha ◽  
Prabin Bikram Thapa ◽  
Dhiresh Kumar Maharjan ◽  
Tseten Yonjan Tamang
Keyword(s):  
Glyceryl Trinitrate ◽  
Anal Fissure ◽  
Chronic Anal Fissure ◽  
Demographic Data ◽  
College Teaching ◽  
Complete Healing ◽  
Medical College ◽  
Main Complaint ◽  
Ischemic Ulcer

Introduction: Anal fissure is an ischemic ulcer caused by combination of spasm of internal anal sphincter and poor blood supply to the posterior midline of anal canal. This study aimed to assess the efficacy of Glyceryl Trinitrate and Nifedipine in the treatment of chronic anal fissure. Methods: Ninety patients with symptomatic anal fissure in Kathmandu Medical College Teaching Hospital are allocated for study in two groups of 45 each from March 2013 to April 2014. The patients are assigned alternatively to GTN group and Nifedipine group. All patients were assessed every week till 8 weeks in regards to headache, compliance, healing and recurrence. The patients who had complete healing in 8 weeks were further followed up for 6 weeks to detect recurrence. Results: Patients in the two groups were comparable in regard to demographic data (age and sex) as well as clinical factors. Headache was main complaint of patients using GTN in high percentage (16.6%) than complained by patients using topical Nifedipine (6.9%). This factor led to poor compliance with GTN compared with Nifedipine.  Nifedipine showed better healing rate 82.5% compared with GTN 60%. Recurrence was comparable among the two groups. Conclusions: Nifedipine ointment showed better results than GTN ointment in chronic anal fissure regarding headache, compliance, healing and recurrence in 6 weeks of follow up period after complete healing of fissure in 8 weeks. Keywords: anal fissure; glyceryl trinitrate; nifedipine.

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