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Brisinda G, Fico V, Tropeano G, Altieri G, Chiarello MM. Effectiveness and safety of botulinum toxin injection in the treatment of recurrent anal fissure following lateral internal sphincterotomy: cohort study. BJS Open 2024; 8:zrad156. [PMID: 38323879 PMCID: PMC10848301 DOI: 10.1093/bjsopen/zrad156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/03/2023] [Accepted: 11/18/2023] [Indexed: 02/08/2024] Open
Affiliation(s)
- Giuseppe Brisinda
- University Department of Translational Medicine and Surgery, Catholic School of Medicine, Rome, Italy
- Emergency and Trauma Surgery Unit, Department of Abdominal and Endocrine Metabolic Medical and Surgical Sciences, Fondazione Policlinico Universitario A Gemelli, IRCS, Rome, Italy
| | - Valeria Fico
- Emergency and Trauma Surgery Unit, Department of Abdominal and Endocrine Metabolic Medical and Surgical Sciences, Fondazione Policlinico Universitario A Gemelli, IRCS, Rome, Italy
| | - Giuseppe Tropeano
- Emergency and Trauma Surgery Unit, Department of Abdominal and Endocrine Metabolic Medical and Surgical Sciences, Fondazione Policlinico Universitario A Gemelli, IRCS, Rome, Italy
| | - Gaia Altieri
- Emergency and Trauma Surgery Unit, Department of Abdominal and Endocrine Metabolic Medical and Surgical Sciences, Fondazione Policlinico Universitario A Gemelli, IRCS, Rome, Italy
| | - Maria Michela Chiarello
- General Surgery Operative Unit, Department of Surgery, Provincial Health Authority, Cosenza, Italy
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Murad-Regadas SM, Regadas FSP, Dias Mont'Alverne RE, da Silva Fernandes GO, de Souza MM, Frota NDA, Ferreira DG. Impact of Internal Anal Sphincter Division on Continence Disturbance in Female Patients. Dis Colon Rectum 2023; 66:1555-1561. [PMID: 37606632 DOI: 10.1097/dcr.0000000000002985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
BACKGROUND Few studies measured the pre- and postoperative anatomic and functional anal canal using 3-dimensional endoanal ultrasound and anal manometry and correlated sphincter division with fecal incontinence, severity, and function. OBJECTIVE To assess the incidence of fecal incontinence in patients who underwent internal anal sphincter division for anal fissure or intersphincteric anal fistula and correlate severity of symptoms with percentage of divided muscle, anatomical measurements, and anal pressures. DESIGN Prospective cohort study. SETTINGS Colorectal surgery unit, tertiary referral center. PATIENTS Patients underwent clinical assessment using the Cleveland Clinic Florida Fecal Incontinence score for severity of symptoms, manometry, and ultrasound. MAIN OUTCOMES MEASURES Ultrasound measurements of length, percentage, and angle of divided internal anal sphincter, anterior external anal sphincter, posterior external anal sphincter plus puborectalis, and gap lengths. RESULTS Sixty-three women (mean age, 44 years) were divided into 2 groups: 30 (48%) underwent fistulotomy for intersphincteric anal fistula and 33 (52%) underwent sphincterotomy for chronic anal fissure with high anal resting pressure. Forty-six percent experienced some measure of fecal incontinence after internal anal sphincter division. Incidence of fecal incontinence, severity of symptoms, and angle of the divided internal anal sphincter were similar between the groups. Length and percentage of the divided internal anal sphincter were significantly higher in the intersphincteric anal fistula. External anal sphincter and external anal sphincter plus puborectalis lengths were similar in both groups. Gap length was significantly longer in chronic anal fissures with high anal resting pressure. LIMITATIONS Single-institution, exclusion of males. CONCLUSIONS Fecal incontinence was reported in half of the patients who underwent internal anal sphincter division. Despite the greater length and percentage of internal anal sphincter division in patients who underwent fistulotomy, incidence and severity of fecal incontinence were similar in both groups. Three-dimensional endoanal ultrasound showed greater gap length in the sphincterotomy group, which may be functionally significant after the division of the shorter internal anal sphincter but with a similar impact on fecal incontinence in both groups. IMPACTO DE LA DIVISIN DEL ESFNTER ANAL INTERNO EN LA ALTERACIN DE LA CONTINENCIA EN PACIENTES DE SEXO FEMENINO ANTECEDENTES:Pocos estudios han medido el canal anal anatómico y funcional antes y después de la cirugía mediante ecografía endoanal tridimensional y manometría anal, y correlacionado la división del esfínter con la incontinencia fecal, la gravedad y la función.OBJETIVO:Evaluar la incidencia de incontinencia fecal en pacientes sometidos a división del esfínter anal interno por fisura anal o fístula anal interesfinteriana, y correlacionar la gravedad de los síntomas con el porcentaje de músculo dividido, las medidas anatómicas y las presiones anales.DISEÑO:Estudio de cohorte prospectivo.AJUSTE:Unidad de cirugía colorrectal, centro de referencia de tercer nivel.PACIENTES:Pacientes sometidos a una evaluación clínica utilizando la puntuación de incontinencia fecal de Cleveland Clinic Florida para la gravedad de los síntomas, la manometría y la ecografía.PRINCIPALES MEDIDAS DE RESULTADO:Mediciones por ultrasonido de la longitud, el porcentaje y el ángulo del esfínter anal interno dividido y el esfínter anal externo anterior, el esfínter anal externo posterior más el puborrectal y las longitudes del espacio.RESULTADOS:Sesenta y tres mujeres (edad media, 44 años) se dividieron en 2 grupos: 30 (48%) sometidos a fistulotomía por fístula anal interesfinteriana y 33 (52%) sometidos a esfinterotomía por fisura anal crónica con alta presión anal en reposo. El 46% experimentó algún grado de incontinencia fecal después de la división del esfínter anal interno. La incidencia de incontinencia fecal, la gravedad de los síntomas y el ángulo del esfínter anal interno dividido fueron similares entre los grupos. La longitud y el porcentaje del esfínter anal interno dividido fueron significativamente mayores en la fístula anal interesfinteriana. Las longitudes del esfínter anal externo y del esfínter anal externo más el puborrectal fueron similares en ambos grupos. La longitud del espacio fue significativamente mayor en la fisura anal crónica con alta presión anal en reposo.LIMITACIONES:Institución única, exclusión de varones.CONCLUSIÓN:La incontinencia fecal se reportó en la mitad de los pacientes sometidos a división del esfínter anal interno. A pesar de la mayor longitud y porcentaje de división del esfínter anal interno en los pacientes sometidos a fistulotomía, la incidencia y gravedad de la incontinencia fecal fue similar en ambos grupos. La ecografía endoanal tridimensional mostró una mayor longitud del espacio en el grupo de esfinterotomía, lo que puede ser funcionalmente significativo después de la división del esfínter anal interno más corto, pero con un impacto similar en la incontinencia fecal en ambos grupos. (Traducción-Dr. Fidel Ruiz Healy ).
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Affiliation(s)
- Sthela M Murad-Regadas
- Department of Surgery, School of Medicine of the Federal University of Ceará, Fortaleza, Ceará, Brazil
- Colorectal Division, Clinic of Coloproctology and Gastroenterology of Ceará, Fortaleza-CE, Brazil
| | - Francisco Sergio P Regadas
- Department of Surgery, School of Medicine of the Federal University of Ceará, Fortaleza, Ceará, Brazil
- Colorectal Division, Clinic of Coloproctology and Gastroenterology of Ceará, Fortaleza-CE, Brazil
| | | | | | - Milena M de Souza
- Department of Surgery, School of Medicine of the Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Nayane de A Frota
- Colorectal Division, Clinic of Coloproctology and Gastroenterology of Ceará, Fortaleza-CE, Brazil
| | - David G Ferreira
- Department of Surgery, School of Medicine of the Federal University of Ceará, Fortaleza, Ceará, Brazil
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Adams ED, Mirocha JM, Fleshner PR, Zaghiyan KN. Efficacy of Anal Sphincter Division During Fistulotomy in Anal Fissure-Associated Fistula. Dis Colon Rectum 2023; 66:716-722. [PMID: 36716394 DOI: 10.1097/dcr.0000000000002700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND A subset of chronic anal fissures beget focal infection, leading to concomitant fistula. The optimal management of fissure-associated fistula is unknown. OBJECTIVE This study aimed to characterize healing rates and effects of fistulotomy in fissure-associated fistula. DESIGN Retrospective study. SETTING Urban tertiary center. PATIENTS Adults who underwent fistulotomy for a fistula associated with a chronic anal fissure were included in the study. However, those with Crohn's disease, a history of lateral internal sphincterotomy, and a fistula not amenable to fistulotomy were excluded. INTERVENTIONS Patients were managed with fistulotomy. Fissures were otherwise managed conservatively with a step-up approach. MAIN OUTCOME MEASURES The primary end point was healing, defined as resolution of symptoms and both fistula and fissure wounds within 1 year. Subgroup analysis compared those who underwent subcutaneous fistulotomy (group A) with those who underwent fistulotomy involving anal sphincter fibers (group B). RESULTS Twenty-four of 38 patients (63%) healed with a median overall follow-up of 6.6 months (4.2-14.1). The overall median time to healing was 4.4 months (2.2-6.0). No clinical or pathologic factors predicted healing. In subgroup analysis, overall subcutaneous fistulotomy healing rates were nonstatically lower at 46% (6/13) compared to fistulotomy involving anal sphincter fibers at 72% (18/25; p = 0.16). There was no difference in time to healing (subcutaneous fistulotomy, 6.7 mo [5.2-8.4] vs fistulotomy involving sphincter, 5.1 mo [2.1-7.0]; p = 0.36). LIMITATIONS The limitations include treatment bias, with increased utilization of chemical sphincter-relaxing agents in those who did not heal. Findings are not applicable to complex fistulas, Crohn's disease, or atypical fissures. CONCLUSIONS Patients presenting with chronic fissure and associated subcutaneous, intersphincteric, or low transphincteric fistula are successfully managed with fistulotomy. Patients with a subcutaneous fistula tract exhibited nonstatistically significantly lower rates of healing. See Video Abstract at http://links.lww.com/DCR/C145 . EFICACIA DE LA DIVISIN ESFINTRICA DURANTE LA FISTULOTOMA EN CASOS DE FSTULA ASOCIADA A FISURA ANAL ANTECEDENTES: Ciertos subgrupos de fisuras anales crónicas ocasionan infección localizada, induciendo la aparición de una fístula anal concomitante. Se desconoce el manejo óptimo de la fístula concomitante a una fisura anal.OBJETIVO: Se trata de caracterizar las tasas de curación y el efecto de la fistulotomía en el tratamiento de la fístula concomitante a la fisura anal.DISEÑO: Estudio retrospectivo.EMPLAZAMIENTO: Centro terciario urbano.PACIENTES: Adultos sometidos a fistulotomía por una fístula concomitante a una fisura anal crónica. Se excluyeron la enfermedad de Crohn, el antecedente de una esfinterotomía lateral interna y las fístulas no susceptibles de fistulotomía.INTERVENCIONES: Los pacientes fueron manejados con una fistulotomía clasica. Por lo demás, las fisuras se trataron de forma conservadora con un enfoque médico escalonado.PRINCIPALES MEDIDAS DE RESULTADO: El criterio principal de valoración fué la cura definitiva, determinada como la resolución completa de los síntomas y de las heridas tanto de la fístula como de la fisura en el plazo de un año. El análisis de los subgrupos comparó los que se sometieron a una fistulotomía subcutánea (grupo A) versus una fistulotomía que involucró las fibras del esfínter anal interno (grupo B).RESULTADOS: 24/38 pacientes (63%) curaron con una mediana de seguimiento global de 6,6 meses (4,2-14,1). El tiempo medio general de curación fue de 4,4 meses (2,2-6,0). Ningún factor clínico o patológico predijo la cura. En el análisis de subgrupos, las tasas generales de cura de la fistulotomía subcutánea no fueron estadísticamente más bajas de 46 % (6/13) comparados con la fistulotomía que involucró las fibras del esfínter anal interno en 72 % (18/25; p = 0,16). No hubo diferencia en el tiempo de cicatrización [fistulotomía subcutánea 6,7 meses (5,2-8,4) conparada a la fistulotomía y esfínterotomía parcial interna a 5,1 meses (2,1-7,0); p = 0,36].LIMITACIONES: Sesgo del tratamiento, con mayor utilización de agentes químicos relajantes de la musculatura esfínteriana en aquellos pacientes que no sanaron. No aplicable a fístulas complejas, enfermedad de Crohn o fisuras atípicas.CONCLUSIÓNES: Los pacientes que presentan fisura crónica y fístula subcutánea, inter-esfintérica o trans-esfintérica baja concomitante se manejan con éxito con una fistulotomía. Los pacientes con un trayecto de fístula subcutánea exhibieron tasas de curación más bajas y no estadísticamente significativas. Consulte Video Resumen en http://links.lww.com/DCR/C145 . (Traducción-Dr. Xavier Delgadillo ).
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Affiliation(s)
- Evan D Adams
- Department of General Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - James M Mirocha
- Biostatistics and Bioinformatics Research Center, Cedars-Sinai Medical Center, Los Angeles, California
| | - Phillip R Fleshner
- Division of Colorectal Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Karen N Zaghiyan
- Division of Colorectal Surgery, Cedars-Sinai Medical Center, Los Angeles, California
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Soldatov D, Staroverov I, Sorogin A, Ryazantseva E, Lonchakova O. [DYNAMICS OF INFLAMMATORY MARKERS AFTER SURGERY ON THE DISTAL RECTUM]. Georgian Med News 2021:7-13. [PMID: 34897036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Objective - to compare the concentrations of inflammatory markers interleukin-6, CRP, and lactoferrin in the serum of patients with benign diseases of the rectum, depending on the volume of surgical intervention and evaluate their changes in different periods after surgery. Been surveyed 92 patients: 54 patients (control group) were operated on for one of the three diseases - chronic hemorrhoids, fistula rectum and chronic anal fissure, 38 patients (main group) operated simultaneously over two or more diseases (combined pathology), where the main were diagnosed with the above diseases. In both groups of patients was determined concentration of interleukin-6, CRP and lactoferrin in serum before surgery, on 3 and 7 days after surgery. There is no communication with the volume of intervention co-operations in the distal rectum with the severity of the systemic inflammatory response. Not identified authentic differences in changes in the concentration of inflammatory markers interleukin-6, C-reactive protein, and lactoferrin in patients operated on for one disease and in patients with combined pathology of the distal colon. The concentration of all investigated markers before operation was higher in both groups of patients diagnosed with anal fissure. The exceptions were the main group of patients with chronic hemorrhoids, in which the concentration of lactoferrin was higher than that of the same group of patients with a diagnosis of the fistula of the rectum and anal fissure. Regardless of the volume of intervention and the type of the marker in patients diagnosed with rectal fistula most pronounced inflammatory reaction was observed on 3-rd day after surgery. Regardless of the volume of operative intervention and nosology on 7-th day after the operation the majority of the studied parameters values approached preoperative, with the exception of both groups consisted of patients diagnosed with anal fissure. Increased of volume of surgical intervention does not lead to a authentic increase in performance of the inflammatory response in patients with combined pathology.
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Affiliation(s)
- D Soldatov
- 1Yaroslavl Regional Clinical Hospital, Yaroslavl, Russian Federation; Russian Federation
| | - I Staroverov
- 2Department of Surgery «Yaroslavl State Medical University», Faculty of Post-Diploma Professional Education and Education of Personnel of Highest Qualification, Ministry of Health of the Russian Federation, Yaroslavl, Russian Federation
| | - A Sorogin
- 1Yaroslavl Regional Clinical Hospital, Yaroslavl, Russian Federation
| | - E Ryazantseva
- 1Yaroslavl Regional Clinical Hospital, Yaroslavl, Russian Federation
| | - O Lonchakova
- 2Department of Surgery «Yaroslavl State Medical University», Faculty of Post-Diploma Professional Education and Education of Personnel of Highest Qualification, Ministry of Health of the Russian Federation, Yaroslavl, Russian Federation
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Eléouet-Kaplan M. [Main traps in proctology]. Rev Prat 2019; 69:67-70. [PMID: 30983292] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Main traps in proctology. Traps are numerous in proctology. Avoiding the clinical examination is the most common. Hemorrhoids are often challenged, while the abscess and the anal fissure are very common. Screening for colorectal cancer is essential in case of rectal bleeding, and the anus should be examined in search of cancer of the anal canal. The clinical examination must be comfortable for the physician and for the patient: it is now done usually lying on the left side, knees up to the breast. Treatments are easy to be prescribed in consultation. It is often necessary to regulate transit and to relieve the pain. The incision of abscess or thrombosis is also simple to achieve. Many french guidelines exist to guide the management of patients.
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Freymond JM, Chautems R, Della Santa V, Wolter L. [Proctological emergencies in pregnant women]. Rev Med Suisse 2018; 14:1394-1396. [PMID: 30091329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Hemorrhoids affect up to 85 % of pregnant women during the last two trimesters. The maximum incidence for anal fissure is 20 %. One of the common risk factors is constipation promoted during pregnancy. The history of anal pathology, the length of delivery and the baby's birth weight also promote these two entities. The treatment includes above all hygiene and dietary measures to prevent constipation and conservative measures (local anesthetics, sitz baths). Surgical procedures should be avoided and indicated only in case of failure of conservative treatment. Rectal prolapse is more rare and must be reduced manually before surgery. Measures to prevent constipation also apply.
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Affiliation(s)
- Jean-Marie Freymond
- Département des urgences, HNE, site de Pourtalès, 45 rue de la Maladière, 2000 Neuchâtel
| | - Roland Chautems
- Département de chirurgie, HNE, site de Pourtalès, 45 rue de la Maladière, 2000 Neuchâtel
| | - Vincent Della Santa
- Département des urgences, HNE, site de Pourtalès, 45 rue de la Maladière, 2000 Neuchâtel
| | - Line Wolter
- Département des urgences, HNE, site de Pourtalès, 45 rue de la Maladière, 2000 Neuchâtel
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Bouchard D, Pigot F. [Anal acute pain]. Rev Prat 2017; 67:148-151. [PMID: 30512847] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Anal acute pain. Anal pain is a symptom commonly reported during consultation for ano-rectal disease. It is a nonspecific symptom, associated with both emergency and chronic pathologies, and with both benign and serious conditions. Aetiological diagnosis is not always easily established during initial visit. In a patient without significant past medical history, when no sign of severe problem is present, and when clinical examination is normal, a second visit can help establishing diagnosis. When an abscess is suspected, antibiotherapy will not cure the patient, and may expose to occurrence of septic complications. When immediate intervention for an abscess is not possible, incision will control pain and infection for a few days. Haemorrhoidal thrombosis is another frequent aetiology of acute pain. Diagnosis is not difficult, and when appropriate medical treatment does not alleviate pain, incision under local anaesthesia is indicated. Pain associated with anal fissure is typicaly ryhthmed by stool passage. For non healing fissures, surgery may be proposed. Fecaloma, trauma, herpes virus infection and foreign body are less frequent, and clinical context is often suggestive.
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Affiliation(s)
| | - François Pigot
- Service de proctologie, maison de santé protestante, Talence, France
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Fathallah N, Barre A, Crochet É, Pommaret É, De Parades V. [Management of anorectal bleeding]. Rev Prat 2017; 67:152-159. [PMID: 30512848] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Management of anorectal bleeding. Anorectal bleeding is a common reason for consultation in general medical practice. The ano-rectal origin is suspected on the characteristics of the bleeding which is often scant and bright red color. Medical history and clinical examination alone are often sufficient to make a diagnosis, since the main causes are hemorrhoids and anal fissure. On the other hand, the estimated risk of anorectal tumours in patients with ano-rectal bleeding has been reported in about 10%. Colonoscopy is therefore necessary at the slightest diagnostic doubt and, anyway, in all patients aged over 45 years.
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Affiliation(s)
- Nadia Fathallah
- Service de proctologie médico-chirurgicale, institut Léopold-Bellan, groupe hospitalier Paris-Saint-Joseph, Paris, France
| | - Amélie Barre
- Service de proctologie médico-chirurgicale, institut Léopold-Bellan, groupe hospitalier Paris-Saint-Joseph, Paris, France
| | - Élise Crochet
- Service de proctologie médico-chirurgicale, institut Léopold-Bellan, groupe hospitalier Paris-Saint-Joseph, Paris, France
| | - Élise Pommaret
- Service de proctologie médico-chirurgicale, institut Léopold-Bellan, groupe hospitalier Paris-Saint-Joseph, Paris, France
| | - Vincent De Parades
- Service de proctologie médico-chirurgicale, institut Léopold-Bellan, groupe hospitalier Paris-Saint-Joseph, Paris, France
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Vergara-Fernández O, Salgado-Nesme N, Navarro-Navarro A, Rangel-Ríos HA. Meta-analysis of botulinum toxin injection for chronic anal fissure: healing rates controversies. Tech Coloproctol 2016; 21:169. [PMID: 27942964 DOI: 10.1007/s10151-016-1563-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 11/22/2016] [Indexed: 11/26/2022]
Affiliation(s)
- O Vergara-Fernández
- Instituto Nacional de Ciencias Medicas y Nutricion, Salvador Zubiran, Mexico City, Mexico.
| | - N Salgado-Nesme
- Instituto Nacional de Ciencias Medicas y Nutricion, Salvador Zubiran, Mexico City, Mexico
| | - A Navarro-Navarro
- Instituto Nacional de Ciencias Medicas y Nutricion, Salvador Zubiran, Mexico City, Mexico
| | - H A Rangel-Ríos
- Instituto Nacional de Ciencias Medicas y Nutricion, Salvador Zubiran, Mexico City, Mexico
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Nelson R. Anal fissure (chronic). BMJ Clin Evid 2007; 2007:0407. [PMID: 19454118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Anal fissures are a common cause of anal pain during, and for 1-2 hours after, defecation. The cause is not fully understood, but low intake of dietary fibre may be a risk factor. METHODS AND OUTCOMES We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of non-surgical treatments for chronic anal fissure? What are the effects of surgical treatments for chronic anal fissure? We searched: Medline, Embase, The Cochrane Library and other important databases up to January 2007 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS We found 11 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS In this systematic review we present information relating to the effectiveness and safety of the following interventions: anal advancement flap; anal stretch/dilation; botulinum A toxin-haemagglutinin complex alone or with nitrates; calcium channel blockers; internal anal sphincterotomy; and nitric oxide donors.
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Abstract
PURPOSE This study was designed to create and evaluate an experimental porcine model of fistula-in-ano. METHODS Initial cadaveric dissection enabled refinement of the technique for fistula formation and histoanatomical study of the porcine anal canal. Subsequently, three surgically created fistulas were treated by seton drainage in each of eight male pigs (weight, 38-41 kg). After 26 days, magnetic resonance imaging at 1.5 Tesla was performed and setons removed under general anesthesia, enabling clinical and microbiologic track assessment. Two pigs were killed for histologic fistula track assessment. RESULTS Histoanatomical assessment noted a rudimentary internal anal sphincter, together with structures resembling anal glands. Artificial fistulas persisted during seton drainage and were more often associated with fecal than skin-derived organisms compared with both perineal and anal canal swabs (P = 0.002). All six fistulas assessed histologically had a lumen, and abundant surrounding granulation tissue similar to that seen in human fistula-in-ano. Epithelialization was not evident in any track. Fistulas were visualized as high signal tracks using magnetic resonance imaging. CONCLUSIONS Porcine anal anatomy resembles that of humans, and an experimental model proved suitable when assessed by magnetic resonance imaging, microbiology, and histologically, which demonstrated abundant granulation tissue. This model could be further used to investigate fistula treatments.
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Abstract
The notes of 214 children who, over a period of 7 years, had been referred after an allegation or a suspicion of any form of child abuse, were examined retrospectively to establish the pattern of injury found, especially with regard to anal fissures or scars. These were all children who had had their genitalia examined at the time of their referral. In 81 children (Group A) who had no history or evidence of sexual abuse, two fissures were found, both with medical explanations for their presence. In 83 (Group B) who alleged sexual abuse but denied anal abuse, nine (11%) had fissures or scars, and in four of the nine there was a history of significant constipation at some time. In 50 children (Group C) who had a strong history of anal abuse, 41 (84%) had fissures or scars. The diagnosis in 13 of these cases was considered definite because there was a confession or guilty plea from the abuser; in the remainder, the diagnosis was "not proven" despite a strong history or gross anal signs and regardless of the verdict in court proceedings. The significance of the findings was discussed with a view to clarifying the relative importance of anal fissures in children with a strong history of anal abuse.
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Pigot F. [Synopsis: Pelvic rectal static disorders]. Gastroenterol Clin Biol 2001; 25:982-8. [PMID: 11845049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Affiliation(s)
- F Pigot
- Service de Proctologie, Hôpital Bagatelle, 33401 Talence Cedex, France
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Affiliation(s)
- D Pashankar
- Division of Gastroenterology, British Columbia's Children's Hospital, Vancouver, Canada
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Thomson H. Fissure-in-ano. Nurs Times 1977; 73:783-4. [PMID: 866232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Smirnova NN. [Anal fissures]. Feldsher Akush 1975; 40:24-8. [PMID: 1038371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Barrelet V, Merz WR. [Gynecologic fistulae]. Rev Med Suisse Romande 1974; 96:437-44. [PMID: 4844796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Cooper DK, Smellie WA. Associated carcinomata of colon and anus. Proc R Soc Med 1973; 66:686-7. [PMID: 4354904 PMCID: PMC1645047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Abstract
In 33 patients with an intersphincteric abscess continuous anal pain was the commonest symptom and a lump in the wall of the anal canal the commonest sign.The importance of this condition as a cause of persistent undiagnosed anal pain is stressed.
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Malafosse M. [Anorectal lesions in Crohn's disease]. Rev Prat 1972; 22:1859-65. [PMID: 4646989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Bensaude A. [Anal fissure]. Rev Prat 1972; 22:1779-91. [PMID: 4539598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Arnous J, Parnaud E, Denis J. [Abscesses and fistula of the anus (apropos of 3000 operations)]. Rev Prat 1972; 22:1793-814. [PMID: 4646987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Stescobich D, Donadío R, Mas L, Rozier EG, Pundyk C, González Aguilar O. [Anal fistula. Statistics, surgical criteria and results]. Prensa Med Argent 1969; 56:1615-6. [PMID: 5399412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Duhamel J. [Anal fissures in children. (Apropos of 100 cases)]. Arch Fr Pediatr 1967; 24:1131-4. [PMID: 5590822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Sherman NJ, Clatworthy HW. Gastrointestinal bleeding in neonates: a study of 94 cases. Surgery 1967; 62:614-9. [PMID: 5299293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Asnach IT. [Anal fissure]. Sov Zdravookhr Kirg 1966; 2:60-1. [PMID: 5988545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Drake LJ. [Anal diseases and lesions]. Infirm Can 1966; 8:32-3. [PMID: 5176053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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WATTS JM. FISSURE IN ANO. Nurs Times 1965; 61:794-5. [PMID: 14292330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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Tylicki M. [Anal fissure]. Pol Tyg Lek 1965; 20:848-50. [PMID: 5841124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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MILSTEIN J. [FISTULOGRAPHY OF ANORECTAL AND NEIGHBORING LESIONS]. Concours Med 1965; 87:2731-7. [PMID: 14343819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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MAGALHAES JP. [ANO-RECTAL ABSCESSES]. Folha Med 1965; 50:181-7. [PMID: 14332124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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DAOUD B. [TREATMENT OF LARGE HEMORRHOIDS BY THE RESECTION OF THE CIRCULAR MUCOSA AND SECTION OF THE ANAL SPHINCTER]. Tunis Med 1965; 43:167-9. [PMID: 14343717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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BROWN BS. DEFECOGRAPHY OR ANORECTAL STUDIES IN CHILDREN INCLUDING CINEFLUOROGRAPHIC OBSERVATIONS. J Can Assoc Radiol 1965; 16:66-76. [PMID: 14280432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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