S3-Leitlinie: Analfissur: AWMF-Registriernummer: 081-010

[Current guidelines for the management of anogenital diseases]

BACKGROUND

Anogenital disorders encompass a broad spectrum of conditions with diverse pathogenetic origins, often presenting with nonspecific symptoms and overlapping causative factors, thereby posing diagnostic and therapeutic challenges. Effective management requires interdisciplinary knowledge and the use of medical guidelines. Guidelines can play an important role in translating current knowledge into clinical practice and ensuring consistent care, minimizing complications, and optimizing patient outcomes.

OBJECTIVE

The dermatologically relevant guidelines for anogenital disorders, categorized by etiological groups, are reviewed.

MATERIALS AND METHODS

A selective literature review was conducted, incorporating data from the guideline repository of the Association of the Scientific Medical Societies in Germany (AWMF).

RESULTS

A broad range of current guidelines pertinent to the management of anogenital disorders with relevance for dermatologists is available. These encompass guidelines for the management of chronic inflammatory dermatoses with (potential) involvement of the anogenital region, such as anal eczema, psoriasis, lichen sclerosus, or lichen ruber, as well as sexually transmitted infections and associated conditions, involving a broad range of pathogens, including gonorrhea, chlamydia, syphilis, or human papillomaviruses (HPV)-associated disorders. In this article, we provide an overview of the available guidelines.

CONCLUSION

The present article does not claim to be exhaustive. The validity of the mentioned guidelines and the availability of updates needs to be verified in each case.

Proktologie

This article provides a practice-oriented overview of the most common proctological diseases: Anal eczema, hemorrhoidal disease, anal thrombosis, marisca, anal abscess and fistula, and anal fissure. Definitions and etiopathogenesis, clinic and diagnostics, and current therapy are presented.

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

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.

Fisurectomy and anoplasty with botulinum toxin injection in patients with chronic anal posterior fissure with hypertonia: a long-term evaluation

Chronic anal fissure’s (CAF) etiopathogenesis remain unclear. CAF of the posterior commissure (CAPF) are often characterized by internal anal sphincter (IAS) hypertonia. The treatment of this disease aimed to reduce IAS hypertonia. Due to the high rate of anal incontinence after LIS, the employment of sphincter preserving surgical techniques associated to pharmacological sphincterotomy appears more sensible. The aim of our study is to evaluate the long-term results of fissurectomy and anoplasty with V–Y cutaneous flap advancement associated to 30 UI of botulinum toxin injection for CAPF with IAS hypertonia. We enrolled 45 patients undergone to fissurectomy and anoplasty with V–Y cutaneous flap advancement and 30 UI botulinum toxin injection. All patients were followed up for at least 5 years after the surgical procedure, with evaluation of anal continence, recurrence rate and MRP (Maximum resting pressure), MSP (Maximum restricting pressure), USWA (Ultrasound wave activity). All patients healed within 40 days after surgery. We observed 3 “de novo” post-operative anal incontinence cases, temporary and minor; the pre-operative ones have only temporary worsened after surgery. We reported 3 cases of recurrences, within 2 years from surgery, all healed after conservative medical therapy. At 5 year follow-up post-operative manometric findings were similar to those of healthy subjects. At 5 years after the surgical procedure, we achieved good results, and these evidences show that surgical section of the IAS is not at all necessary for the healing process of the CAPF.