- Posterolateral versus lateral internal anal sphincterotomy in the treatment of chronic anal fissure: a randomized controlled trial. [Journal Article]
- IJInt J Colorectal Dis 2018 May 19
- CONCLUSIONS: Time to complete healing was significantly shorter and pain score was significantly lower after PLIS than after LIS which can be due to more reduction in the resting anal pressure after PLIS. Continence disturbances occurred after PLIS less frequently than after LIS; however, no significant differences between the two techniques were noted.
- Preemptive Analgesia Decreases Pain Following Anorectal Surgery: A Prospective, Randomized, Double-Blinded, Placebo-Controlled Trial. [Journal Article]
- DCDis Colon Rectum 2018 May 15
- CONCLUSIONS: This study was limited by the small sample size and excellent pain control in both groups.Preemptive analgesia is safe and results in decreased pain in the early postoperative period following anorectal surgery. It should be implemented by surgeons performing these procedures. See Video Abstract at http://links.lww.com/DCR/A588.
- [Acute anal fissure]. [Review]
- MFMMW Fortschr Med 2018; 160(9):47
- Long-term Outcome of a Fissurectomy: A Prospective Single-Arm Study of 50 Operations out of 349 Initial Patients. [Journal Article]
- ACAnn Coloproctol 2018; 34(2):83-87
- CONCLUSIONS: A fissurectomy for the treatment of patients with an idiopathic noninfected fissure is associated with rapid pain relief and a high success rate even though complete healing may often be delayed. Moreover, it appears to have no adverse effect on continence.
- Open surgery for haemorrhoids in persons with spinal cord injury. [Journal Article]
- SCSpinal Cord Ser Cases 2018; 4:35
- CONCLUSIONS: Open surgery procedures were well tolerated and should be considered in persons with SCI.
- StatPearls [BOOK]
- BOOKStatPearls Publishing: Treasure Island (FL)
- An anal fissure is a common benign anorectal disease affecting both children and adults. It is defined as a painful linear tear in the posterior anoderm extending cephalad to the dentate line. Classi...
An anal fissure is a common benign anorectal disease affecting both children and adults. It is defined as a painful linear tear in the posterior anoderm extending cephalad to the dentate line. Classically these are caused by a large, firm, forceful bowel movement. This results in cycles of recurring anal pain and bleeding leading to chronic anal fissures in as many as 40% of patients who develops fissures. An anal fissure can typically be diagnosed based on history alone. Patients will describe moderate to severe anal pain with bowel movements with variable amounts of bleeding. The bleeding is described as blood on the toilet paper with wiping. The pain commonly persists for 15 to 30 minutes following a bowel movement. The exposed internal anal sphincter frequently spasms, leading to significant pain. If this persists, this muscle becomes hypertrophied leading to nonhealing anal fissures. Typically, in children, these are self-limiting, whereas in adults these can require surgical intervention. The majority of anal fissures (90%) are located in the posterior midline. Fissures can be located in the anterior midline in as many as 25% of females and 8% of males. Fissures in the lateral position should raise concern for other disease processes like inflammatory bowel disease or granulomatous diseases. There are several medical therapies including salves, fiber and topical nitroglycerin that aids in spontaneous closure early in the disease process. Surgical therapies include botulinum toxin injections, fissurectomy, advancement flaps, and internal lateral anal sphincterotomy. Surgical intervention is typically indicated with chronic fissures or for fissures that are not amenable to medical therapy. Internal lateral anal sphincterotomy provides prompt symptomatic relief and has greater than 95% cure rate at 3 weeks post-procedure. Currently, it is considered the gold standard surgical intervention.
- Anal tone may predict recurrence after botulinum toxin for chronic anal fissure. [Letter]
- AJANZ J Surg 2018; 88(4):385-386
- Coloproctology procedure clinic: a novel service developed to reduce suffering of patients with bleeding per rectum. [Journal Article]
- IJIr J Med Sci 2018 Mar 22
- CONCLUSIONS: Establishing a dedicated "Coloproctology procedure clinic" is an effective strategy in reducing number of hospital visits per patient and hospital waiting list. This innovative clinic reduces utilisation of precious endoscopy unit resources. This ultimately will improve endoscopy efficiency.
- Treatment algorithm for anal fissure. Consensus document of the Spanish Association of Coloproctology and the Coloproctology Division of the Spanish Association of Surgeons. [Journal Article]
- CECir Esp 2018; 96(5):260-267
- The Spanish Association of Coloproctology and the Coloproctology Division of the Spanish Association of Surgeons propose this consensus document with a treatment algorithm for anal fissure that could...
The Spanish Association of Coloproctology and the Coloproctology Division of the Spanish Association of Surgeons propose this consensus document with a treatment algorithm for anal fissure that could be used for decision making. Non-surgical therapy and surgical treatment of anal fissure are explained, and the recommended algorithm is provided. The methodology used was: creation of a group of experts; search in PubMed, MEDLINE and the Cochrane Library for publications from the last 10 years about anal fissure; presentation at the 21st National Meeting of the Spanish Association of Coloproctology Foundation 2017 with voting for/against each conclusion by the attendees and review by the scientific committee of the Spanish Association of Coloproctology.
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- Comment on: Botulinum toxin injection vs topical nitrates for chronic anal fissure: an updated systematic review and meta-analysis of randomized controlled trials. [Letter]
- CDColorectal Dis 2018; 20(5):451