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Tsunoda A, Kusanagi H. Enhanced Approach to Treating Chronic Anal Fissures: Fissurectomy with Vertical Non-full-thickness Midline Sphincterotomy and Mucosal Advancement Flap. J Anus Rectum Colon 2024; 8:111-117. [PMID: 38689786 PMCID: PMC11056538 DOI: 10.23922/jarc.2023-072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/06/2024] [Indexed: 05/02/2024] Open
Abstract
Objectives Lateral internal sphincterotomy is a conventional surgical intervention for chronic anal fissures, yet the potential for postoperative anal incontinence underscores the need for an alternative approach. This study aimed to evaluate the outcomes of patients with chronic fissures who underwent a combination of fissurectomy, vertical non-full thickness midline sphincterotomy (VNMS), and mucosal advancement flap (MAF), as a means of mitigating the risk of incontinence. Methods This retrospective analysis included forty-six consecutive patients with chronic anal fissures, unresponsive to topical diltiazem, who underwent fissurectomy combined with VNMS and MAF between April 2018 and May 2023. Primary outcome measures encompassed fissure healing rates. Continence was assessed using the Fecal Incontinence Severity Index (FISI), and manometric assessments were conducted before the procedure and three months postoperatively. Results With a median follow-up of 27 months, there were no postoperative complications, and the overall fissure healing rate reached 96% (44/46). At three months post-procedure, FISI scores were reduced to 0, with no instances of fecal soiling. Anal resting pressure exhibited a significant reduction at 3 months [pre-op: 133 (95% CI, 128-150) vs. 3 mo: 109 (95% CI, 100-117) cmH2O; p = 0.01]. Similarly, maximum anal squeeze pressure showed a significant decrease three months post-surgery [pre-op: 317 cmH2O (95% CI, 294-380) vs. 3 mo: 291 cmH2O (95% CI, 276-359), p = 0.03]. Conclusions The combination of fissurectomy, VNMS, and MAF proved to be an effective approach for chronic anal fissures, yielding favorable medium-term outcomes without postoperative anal incontinence.
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Affiliation(s)
- Akira Tsunoda
- Department of Gastroenterological Surgery, Kameda Medical Center, Kamogawa, Japan
| | - Hiroshi Kusanagi
- Department of Gastroenterological Surgery, Kameda Medical Center, Kamogawa, Japan
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Dokcu Ş, Başçeken Sİ. Botulinum toxin injection in outpatients for chronic anal fissure. Acta Chir Belg 2024; 124:131-136. [PMID: 37440688 DOI: 10.1080/00015458.2023.2234179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 07/04/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVES The aim of the study was to evaluate the effect of botulinum toxin (BT) injection on fissure healing in the treatment of chronic anal fissure (CAF) in outpatient conditions without any analgesia and sedation to the internal anal sphincter (IAS). The primary outcome measure was post-procedural pain. The secondary outcome measures were fissure healing and complications. METHODS Prospectively preserved data of 67 patients who received BT injections for CAF were analyzed prospectively. Demographic data, duration of symptomatic improvement, fissure location and number, parity, post-procedural pain, complications, continence status, response to treatment, and duration of follow-up were examined. Participants received bilateral (50 + 50 units) BT injections into the internal anal sphincter (IAS) in an outpatient setting. RESULTS Symptomatic improvement was observed in 58% of patients within 1 week. The complete response rate to treatment was 82% at a mean follow-up of 6 months. Patients with partial response to treatment (10%) were successfully treated with topical therapy, and patients with persisting fissures (8%) were successfully treated with partial lateral internal sphincterotomy (LIS). 14 patients (21%) reported some degree of transient incontinence at follow-up. Multiparous women experienced more symptoms of Incontinence (p = 0.00). Pre- and post-procedural Vas Score median values were 4. The 7th-week VAS score median value was 3. CONCLUSION Dysport injection under sedation-free outpatient conditions is an effective and safe alternative to LIS for the treatment of CAF, with tolerable procedural pain. All patients should be warned of transient incontinence.
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Affiliation(s)
- Şeref Dokcu
- Gazi Yaşargil Training and Research Hospital Surgical Oncology Department, Health Sciences University, Kayapınar Diyarbakır, Turkey
| | - Salim İlksen Başçeken
- Gazi Yaşargil Training and Research Hospital Surgical Oncology Department, Health Sciences University, Kayapınar Diyarbakır, Turkey
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Gökçek E, Gökçe R, Kaçar CK. The effect of Caudal Epidural Injection on healing in the treatment of chronic anal fissure. Medicine (Baltimore) 2023; 102:e35160. [PMID: 37713828 PMCID: PMC10508418 DOI: 10.1097/md.0000000000035160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 08/18/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND Chronic anal fissure is called the reaching the muscle layer under the skin by deepening of the fissure in the breech skin. Our purpose is to enable the tissue to heal by relaxing the anal sphincter with caudal epidural injection. METHODS One hundred twenty cases were included in this randomized, controlled study. The cases were categorized into 2 groups; Under ultrasound guidance, the first group, caudal epidural injection group (Group CE, n = 60) was treated with 5 cc bupivakain + 5 cc isotonic from a caudal epidural for a total of 3 sessions at the beginning, 1 week and 2 weeks later; the second group, control group (Group C, n = 60) were provided medical treatment (cream, pill etc.) every day for 2 weeks. Wexner's constipation score was used to assess constipation severity and visual analog scale was used to assess pain severity. Short Form-36 was used to determine the patient's quality of life. RESULTS This study was conducted with 2 groups of 60 people and a total of 120 patients. There was no statistically significant difference between the groups in terms of demographic characteristics (age, body mass index, gender, American Society of Anesthesiologist, mean blood pressure, heart rate) (P > .05). Out of the detected fissures, 32 (26.7%) were located anteriorly and 88 (73.3%) were located posteriorly. The groups were statistically same in terms of fissure location (P = .423). When groups were compared with pain, Wexner constipation and visual analog scale scores decreased significantly in Group CE compared to Group C after 2.and 3.sessions (P = .001 and P = .002, respectively). In Group CE, the Short Form-36 subscales increased significantly (P = .003). CONCLUSION Caudal epidural injection has a potential to be an alternative treatment option for chronic anal fissure.
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Affiliation(s)
- Erhan Gökçek
- Department of Anaesthesiolgy, Health Sciences University Diyarbakir Gazi Yasargil Research and Education Hospital, Diyarbakir, Turkey
| | - Recep Gökçe
- Department of Anaesthesiolgy, Health Sciences University Diyarbakir Gazi Yasargil Research and Education Hospital, Diyarbakir, Turkey
| | - Cem Kivilcim Kaçar
- Department of Anaesthesiolgy, Health Sciences University Diyarbakir Gazi Yasargil Research and Education Hospital, Diyarbakir, Turkey
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Gulcu B, Ozturk E. Botulinum toxin injection is an effective alternative for the treatment of chronic anal fissure. Acta Chir Belg 2023; 123:12-18. [PMID: 33899686 DOI: 10.1080/00015458.2021.1920778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVES There are few published data on the optimized use of botulinum toxin A (BTA) for the treatment of chronic anal fissure (CAF). The aim of this study was to investigate the effect of injection of 100 IU BTA into the internal anal sphincter (IAS) at the side opposite of the fissure, using an anal retractor, sedation, and perianal transcutaneous pudendal nerve block. METHODS The prospectively maintained data of 132 patients who underwent BTA injection for CAF were retrospectively analyzed. Demographic data, symptom duration, fissure location, post-procedure pain, complications, continence status, response to treatment, and follow-up period were investigated. Postoperative analgesic requirements of patients who did and did not receive pudendal nerve block were compared. RESULTS Eighty-two patients were male and the median age was 40 (18-74) years. Sixty-six patients required no, 46 required oral, and 20 required parenteral analgesics. No complications were observed. Complete response was observed in 105 patients (79.5%). Symptomatic improvement was observed in 67.4% of patients within 3-7 d. Median follow-up was 24 (18-42) months. The median Wexner's incontinence score was 0 (0-8) at 1 month. In all, 104 patients had no, 22 patients had minor, and 6 patients had non-minor incontinence. All patients with incontinence recovered fully within 4 (2-13) weeks. CONCLUSIONS BTA injection using an anal retractor under sedation and perianal transcutaneous pudendal nerve block is an effective and safe alternative to partial lateral internal sphincterotomy (LIS) for the treatment of CAF.
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Affiliation(s)
- Baris Gulcu
- Department of Surgery, Bursa Medicana Hospital, Bursa, Turkey
| | - Ersin Ozturk
- Department of Surgery, Bursa Medicana Hospital, Bursa, Turkey.,Department of Surgery, School of Medicine, KTO Karatay University, Konya, Turkey
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Li W, Xu J, Li T, Bi Y, Ren W, Wei S. Efficacy of posterior median anal incision with incision and drainage of the anal sinus on chronic anal fissure. Am J Transl Res 2022; 14:432-439. [PMID: 35173862 PMCID: PMC8829648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 11/30/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND To explore the efficacy of posterior median anal incision plus incision and drainage of anal sinus on chronic anal fissure (CAF), and its influence on incidence and recurrence of postoperative infection. METHODS Altogether 130 patients with CAF treated during January 2017 and January 2021 were included and divided into a research group (RG) and control group (CG). Among them, 80 patients in the RG were treated with posterior median anal incision and expansion plus anal sinus incision and drainage, while 50 in the CG were treated with lateral internal sphincterotomy. Clinical indexes (wound healing time, recovery time of bowel sounds, intraoperative blood loss, length of stay), levels of inflammatory factors (IL-6, IL-8, CRP) before and one week after treatment, changes of psychological and emotional scores (SAS, SDS scores) before and 6 months after treatment, sleep and scores of daily activities after admission and 6 months after treatment, VAS scores at 1 day, 1 week and 2 weeks after operation, compliance, total effective rate, and incidence and recurrence rate of postoperative incision infection were compared between the groups. RESULTS Compared with the CG, the wound healing time, recovery time of bowel sounds and length of stay were shorter, and intraoperative blood loss was lower in the RG; the levels of IL-6, IL-8 and CRP were lower in RG one week after treatment. Six months after treatment, the SAS, SDS and PSQI scores were lower, the ADL scores were higher, the compliance and total effective rate were higher, and the incidence and recurrence rate of postoperative incision infection were lower in the RG. CONCLUSION Posterior median anal incision plus incision drainage of the anal sinus has better efficacy on CAF, and can effectively reduce the incidence of postoperative infection and recurrence.
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Affiliation(s)
- Wei Li
- Department of Anorectal Surgery, Jinan City People's Hospital Jinan 271199, Shangdong, China
| | - Jiacheng Xu
- Department of Anorectal Surgery, Jinan City People's Hospital Jinan 271199, Shangdong, China
| | - Tao Li
- Department of Anorectal Surgery, Jinan City People's Hospital Jinan 271199, Shangdong, China
| | - Yuhe Bi
- Department of Anorectal Surgery, Jinan City People's Hospital Jinan 271199, Shangdong, China
| | - Weicai Ren
- Department of Anorectal Surgery, Jinan City People's Hospital Jinan 271199, Shangdong, China
| | - Shengchao Wei
- Department of Anorectal Surgery, Jinan City People's Hospital Jinan 271199, Shangdong, China
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Iacopo G, Tommaso C, Chiara L, Filippo C, Paolo D, Gianni R, Cinzia T, Giuseppina T, Federico B, Alessandra A, Silvia G, Antonella P, Luca G, Claudio E. Scanner-Assisted CO 2 Laser Fissurectomy: A Pilot Study. Front Surg 2022; 8:799607. [PMID: 35028310 PMCID: PMC8748255 DOI: 10.3389/fsurg.2021.799607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 12/02/2021] [Indexed: 11/13/2022] Open
Abstract
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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Affiliation(s)
- Giani Iacopo
- SOSD Proctologia, USL Toscana Centro, Florence, Italy
| | | | - Linari Chiara
- SOSD Proctologia, USL Toscana Centro, Florence, Italy
| | | | - Dreoni Paolo
- SOSD Proctologia, USL Toscana Centro, Florence, Italy
| | - Rossi Gianni
- SOSD Proctologia, USL Toscana Centro, Florence, Italy
| | - Tanda Cinzia
- SOSD Proctologia, USL Toscana Centro, Florence, Italy
| | | | | | | | - Grassi Silvia
- SOSD Proctologia, USL Toscana Centro, Florence, Italy
| | | | - Giannoni Luca
- Department of CRP (Clinical Research and Practice), El.En. Group, Florence, Italy
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Abstract
We aimed to evaluate the efficacy and safety of endoanal ultrasound (EAUS)-guided botulinum toxin (BT) in the treatment of chronic anal fissure (CAF). All patients were classified into 2 groups: conventional and EAUS groups. In total, 90 units of BT were injected into the internal anal sphincter at the 3, 6, and 9 o'clock positions in the EAUS group. An injection was performed into the intersphincteric space at the 3, 6, and 9 o'clock positions in the conventional group. Adverse effects and efficacy were analyzed. There were 44 patients: 26 in the conventional group and 18 in the EAUS group. Pain and incontinence rates were similar between groups (P > .05). The efficacy rate was higher in the EAUS group (69.23%) than in the conventional group (81.82%), but this difference was not significant (P = .466). EAUS-guided BT injection is safe and effective in patients with CAFs.
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Affiliation(s)
- Çagri Akalin
- Department of General Surgery, Ordu Training and Research Hospital, Ordu, Turkey
| | | | - Cihangir Akyol
- Department of General Surgery, Ankara University School of Medicine, Istanbul, Turkey
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Kujur ADS, Paul Ekka NM, Chandra S, Lal S, Malua S. Comparative Study to Assess the Effectiveness of Topical Nifedipine and Diltiazem in the Treatment of Chronic Anal Fissure. J Family Med Prim Care 2020; 9:5652-5657. [PMID: 33532409 PMCID: PMC7842453 DOI: 10.4103/jfmpc.jfmpc_986_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 09/03/2020] [Accepted: 09/15/2020] [Indexed: 12/02/2022] Open
Abstract
Background: Chronic anal fissure is a common condition which is classically treated by surgery which may lead to incontinence. Recently medical treatment in form of calcium channel blockers (CCB) has gained interest. Aims: The aim of this study is to compare the effectiveness of local Nifedipine and Diltiazem with lignocaine as control. We also aimed to observe the clinical pattern of chronic anal fissure. Material and Method: Patients of chronic anal fissure were divided into three groups. First group received topical Nifedipine, second received topical Diltiazem, and the control group received only local lignocaine for 1 month. Their clinical data was recorded. The intensity of pain and bleeding was assessed from a visual analogue score (VAS). On the 4th week patients were examined for healing. Statistical Analysis: Statistical analysis was done by Medcalc statistical software v14. Student's t-test and Chi-square test was used accordingly. Results: Mean age was 35.89 with a male female ratio of 1.7:1. Most common clinical feature was pain (100%), followed by constipation, bleeding, and pruritus. Most common location was posterior. VAS scores for pain of the Nifedipine group and Diltiazem group was significantly better than control group (P < 0.0001). VAS scores for bleeding in the Nifedipine group (P = 0.0091) and Diltiazem group (P = 0.0045) was significantly better than control group. The healing rate for NFD group was 93.33% (P < 0.0001), that of DTZ group was 86.67% (P = 0.0002), which was statistically better than control group (36.67%). There was no significant difference between the two CCBs. Conclusion: Adding topical Nifedipine or Diltiazem in the treatment of anal fissure is far superior to treatment with only topical Lignocaine.
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Affiliation(s)
| | - Nishith M Paul Ekka
- Department of Surgery, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Satish Chandra
- Department of Pharmacology, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Shreya Lal
- Department of Pharmacology, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Shital Malua
- Department of Surgery, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
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Soltany S, Hemmati HR, Toussy JA, Salehi D, Toosi PA. Therapeutic properties of botulinum toxin on chronic anal fissure treatment and the patient factors role. J Family Med Prim Care 2020; 9:1562-1566. [PMID: 32509650 PMCID: PMC7266196 DOI: 10.4103/jfmpc.jfmpc_944_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 02/21/2020] [Accepted: 03/03/2020] [Indexed: 12/28/2022] Open
Abstract
Background: One of the most frequent distressing diseases which causes anal pain and bleeding after defecation is anal fissure. Despite a poorly understood pathogenesis, the internal anal sphincter spasm has been identified to play a central role in pathogenesis. Recently, botulinum toxin is being used increasingly for the treatment of chronic anal fissure to achieve chemical sphincterotomy and reduce internal sphincter tonicity. Based on the heterogeneity among the published studies, we aimed this study to evaluate its healing rate and for recognizing the factors of patients which may affect the outcome. Subjects and Methods: In a prospective case series medical research, 106 patients who suffer from chronic anal fissure were treated by botulinum toxin injections. All patients received 30 units of botulinum toxin and were physically examined every week for 2 months. They were evaluated for bleeding, pain, hematoma, thrombosis, infection, incontinence, and healing of the fissure. At the end of the follow-up period, the fissure healing rate and its relation to age, gender, prior topical therapy, duration of symptoms, and the position of the fissure were assessed. Results: At the end of the study (8 weeks), the healing rate was 84.9% (90 patients responded to injections). Healing rate was higher in females and in patients who experienced a shorter duration of symptoms before injection. The mean healing time was 4.68 weeks. In addition, patients with one fissure (anterior or posterior) demonstrated higher healing rate and shorter healing time compared to patients with two fissures (anterior and posterior). Conclusion: This study demonstrated that botulinum toxin injection is safe and effective for the treatment of chronic anal fissures, with a low complication rate. In addition, the healing rate was higher in females, patients with shorter duration of symptoms, and those with one fissure.
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Affiliation(s)
- Setareh Soltany
- Cancer Research Center, Kowsar Hospital, Semnan University of Medical Sciences, Semnan, Iran
| | - Hamid Reza Hemmati
- Department of Surgery, Kowsar Hospital, Semnan University of Medical Sciences, Semnan, Iran
| | - Jafar Alavy Toussy
- Department of Pathology, Semnan University of Medical Sciences, Semnan, Iran
| | - Dina Salehi
- Department of Medicine, School of Medicine, Semnan University of Medical Sciences, Semnan, Iran
| | - Parisa Alavi Toosi
- Department of Medicine, School of Medicine, Semnan University of Medical Sciences, Semnan, Iran
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Ala S, Enayatifard R, Alvandipour M, Qobadighadikolaei R. Comparison of captopril (0.5%) cream with diltiazem (2%) cream for chronic anal fissure: a prospective randomized double-blind two-centre clinical trial. Colorectal Dis 2016; 18:510-6. [PMID: 26456162 DOI: 10.1111/codi.13147] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 07/17/2015] [Indexed: 02/08/2023]
Abstract
AIM This study compared the efficacy of topical captopril with topical diltiazem in the treatment of chronic anal fissure (CAF). METHOD Fifty patients aged between 15 and 75 years with CAF were included in a prospective randomized, double-blind clinical trial. They were randomly allocated to either captopril (0.5%) cream or diltiazem (2%) cream in a dose of 2 cm of cream on the perianal skin every 12 h for 8 weeks. The intensity of pain upon defaecation was evaluated every 10 days using a visual analogue scale. Bleeding on defaecation, pruritus and the presence of perianal irritation were also recorded before and during the trial. RESULTS The average pain scores were lower in the diltiazem group on the 20th and 30th days. From day 40 to the end of the trial the average pain scores of the two groups did not differ significantly. There were no significant differences in bleeding or perianal irritation between the groups, but the incidence of pruritus was considerably higher in the captopril group, and at the end of the trial 45.8% of the patients in this group still suffered from pruritus. CONCLUSION Topical captopril and diltiazem were found to be equally effective in the management of pain, bleeding and perianal irritation due to CAF, but due to the high incidence of pruritus observed with topical captopril this medication is not recommended for the treatment of CAF.
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Affiliation(s)
- S Ala
- Department of Clinical Pharmacy, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Mazandaran, Iran
| | - R Enayatifard
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Mazandaran, Iran
| | - M Alvandipour
- Department of Surgery, Imam Khomeini General Hospital affiliated to Mazandaran University of Medical Sciences, Sari, Mazandaran, Iran
| | - R Qobadighadikolaei
- Department of Clinical Pharmacy, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Mazandaran, Iran
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Aytac E, Erem HH, Remzi FH, Gorgun E. A novel data collection and monitoring system for health status measures in patients undergoing lateral internal sphincterotomy: The Knowledge Program (TKP). Asian J Surg 2015; 38:134-8. [PMID: 25779887 DOI: 10.1016/j.asjsur.2015.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Accepted: 01/14/2015] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND/OBJECTIVE The Knowledge Program (TKP) allows prospective data collection during routine clinical practice. The aim of this study was to evaluate the efficacy and feasibility of TKP for capturing and monitoring health status measures in patients undergoing lateral internal sphincterotomy (LIS). METHODS TKP data of patients undergoing LIS from December 2008 to May 2013 were retrieved. Health status measures including the Cleveland Global Quality of Life (CGQL), European Quality of Life Index (EQ-5D), Fecal Incontinence Severity Index (FISI), anorectal pain scores, and satisfaction questions were evaluated in the study. RESULTS A total of 500 patients underwent LIS within the study period. Overall patient numbers responding to the health status measures in the pre- and postoperative period were as follows: CGQL: 112 preoperatively, 53 postoperatively; EQ-5D: 112 preoperatively, 55 postoperatively; FISI: 102 preoperatively, 30 postoperatively; and anorectal pain score: 107 preoperatively, 45 postoperatively. Among the responders, the number of patients who completed the health status measures both pre- and postoperatively was as follows: EQ-5D: 31, CGQL: 28, anorectal pain: 24, and FISI: 15. A total of 30 patients completed postoperative satisfaction and recommendation questions. Postoperative earliest (p = 0.02) and most recent (p = 0.01) anorectal pain visual analog scores were significantly lower than the preoperative measurements. The earliest postoperative EQ-5D scores were significantly higher than their preoperative values (p = 0.02). The majority of patients who completed the surveys said they were satisfied (70% and 67%) and would recommended (73% and 70%) LIS to others undergoing postoperative earliest and most recent follow up. CONCLUSION LIS reduces anorectal pain without worsening quality of life. TKP captures information directly from patients and records it to a database which may reduce the risk of information loss or alteration.
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Affiliation(s)
- Erman Aytac
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, OH, United States
| | - Hasan H Erem
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, OH, United States
| | - Feza H Remzi
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, OH, United States
| | - Emre Gorgun
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, OH, United States.
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Bedair EM, El Hennawy HM, Moustafa AA, Meki GY, Bosat BE. Transperineal sonographic anal sphincter complex evaluation in chronic anal fissures. J Ultrasound Med 2014; 33:1981-1989. [PMID: 25336486 DOI: 10.7863/ultra.33.11.1981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES The purpose of this study was to assess the role of transperineal sonography in assessment of pathologic changes to the anal sphincter complex in patients with chronic anal fissures. METHODS We conducted a prospective case-control study of 100 consecutive patients of any age and both sexes with chronic anal fissures who presented to a colorectal clinic between January 2012 and August 2013 (group A) and 50 healthy volunteers (group B). RESULTS The most common patterns of radiologic changes to anal sphincters associated with chronic anal fissures were circumferential thickening of the anal sphincter complex in 5 patients (5%), circumferential thickening of the internal anal sphincter in 3 patients (3%), preferential thickening of the internal anal sphincter at the 6-o'clock position in 80 patients (80%) and the 12-o'clock position in 7 patients (7%), preferential thickening of the internal and external anal sphincters in 3 patients (3%), and thinning of the internal anal sphincter in 2 patients (2%). CONCLUSIONS Chronic anal fissures cause differential thickening of both internal and external anal sphincters, with a trend toward increased thickness in relation to the site of the fissure. Routine preoperative transperineal sonography for patients with chronic anal fissures is recommended, and it is mandatory in high-risk patients.
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Affiliation(s)
- Elsaid M Bedair
- Department of Radiology, Al Khor Hospital, Hamad Medical Corporation, Al Khor, Qatar (E.M.B.); Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar (H.M.E.H.); and Department of Surgery, Faculty of Medicine for Girls, Al Azhar University, Cairo, Egypt (A.A.M., G.Y.M., B.E.B.)
| | - Hany M El Hennawy
- Department of Radiology, Al Khor Hospital, Hamad Medical Corporation, Al Khor, Qatar (E.M.B.); Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar (H.M.E.H.); and Department of Surgery, Faculty of Medicine for Girls, Al Azhar University, Cairo, Egypt (A.A.M., G.Y.M., B.E.B.).
| | - Ahmed Abdu Moustafa
- Department of Radiology, Al Khor Hospital, Hamad Medical Corporation, Al Khor, Qatar (E.M.B.); Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar (H.M.E.H.); and Department of Surgery, Faculty of Medicine for Girls, Al Azhar University, Cairo, Egypt (A.A.M., G.Y.M., B.E.B.)
| | - Gad Youssef Meki
- Department of Radiology, Al Khor Hospital, Hamad Medical Corporation, Al Khor, Qatar (E.M.B.); Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar (H.M.E.H.); and Department of Surgery, Faculty of Medicine for Girls, Al Azhar University, Cairo, Egypt (A.A.M., G.Y.M., B.E.B.)
| | - Bosat Elwany Bosat
- Department of Radiology, Al Khor Hospital, Hamad Medical Corporation, Al Khor, Qatar (E.M.B.); Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar (H.M.E.H.); and Department of Surgery, Faculty of Medicine for Girls, Al Azhar University, Cairo, Egypt (A.A.M., G.Y.M., B.E.B.)
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Aslam MI, Pervaiz A, Figueiredo R. Internal sphincterotomy versus topical nitroglycerin ointment for chronic anal fissure. Asian J Surg 2013; 37:15-9. [PMID: 23972505 DOI: 10.1016/j.asjsur.2013.07.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Revised: 04/22/2012] [Accepted: 07/09/2013] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Anal fissure is a common benign condition. An anorectal problem is defined as a split in the anal canal mucosa that extends from the dentate line to the anal verge. Chronic anal fissure is defined by a history of symptoms present for more than 2 months' duration and with a triad of external skin tags, namely, a hypertrophied anal papilla, an ulcer with rolled edges, and a base exposing the internal sphincter. Because complications such as incontinence are associated with surgical treatment, chemical sphincterotomy is currently favored. OBJECTIVES The objective of this study is to compare the difference in outcome between open partial lateral anal sphincterotomy and application of topical 0.2% nitroglycerin ointment for the treatment of chronic anal fissure. METHODS This was a quasi-experimental study carried out between January 16, 2007 and January 15, 2008 in the Surgical Department of Jinnah Hospital, Lahore, Pakistan. Sixty consecutive cases with a clinical diagnosis of chronic anal fissure were recruited in the study. All recruited patients met the study inclusion criteria and were randomly assigned to one of the two groups. Group A was managed conservatively using topical 0.2% nitroglycerin ointment, whereas Group B underwent open partial lateral anal sphincterotomy. Both groups were followed up at 1 week, 2 weeks, 4 weeks, and 6 weeks after the treatment. RESULTS All the patients complained of pain. A total of 43 (71.7%) patients had pain with constipation, whereas 31 (51.7%) patients had bleeding per rectum. Upon clinically examining the anal area, tenderness was elicited in all 60 (100%) patients. Group A included 30 (11 females and 19 males) cases treated with topical 0.2% nitroglycerin ointment and Group B included 30 (11 females and 19 males) cases who underwent open partial lateral anal sphincterotomy. In Group A, only 15 patients with fissures were successfully treated (50%). By contrast, 28 (93%) patients with fissures in Group B were successfully treated, and only two (7%) remained uncured. These two patients (6.6%) in Group B suffered from incontinence due to flatus and feces as a complication of the procedure. CONCLUSION This quasi-experimental study demonstrates that open partial lateral internal sphincterotomy is superior to topical 0.2% nitroglycerin application in the treatment of chronic anal fissure, with good symptomatic relief, high rate of healing, fewer side effects, and a very low rate of early continence disturbances.
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Affiliation(s)
- Muhammad I Aslam
- Department of Vascular/General Surgery, Queen Elizabeth Hospital, Gateshead, United Kingdom.
| | - Arif Pervaiz
- Surgical Unit I, General Surgery Department, Jinnah Hospital, Lahore, Pakistan
| | - Rodrigo Figueiredo
- Department of Vascular/General Surgery, Queen Elizabeth Hospital, Gateshead, United Kingdom
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