A systematic review and meta-analysis of the treatment of anal fissure

Nelson, Richard L.; Manuel, Douglas; Gumienny, C; Spencer, B; Patel, Kumkum; Schmitt, Katharina; Castillo, Diego Fernando; Bravo, Alejandro; Sampong, Akua

doi:10.1007/s10151-017-1664-2

Cited by 91 publications

(78 citation statements)

References 147 publications

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“…Treatment is aimed at reducing spasm of the IAS, relieving pain and promoting healing of the ulcer. The most effective method for CAF healing is lateral sphincterotomy [2]. Although this procedure is associated with healing rates of greater than 90% [3, 4], there is permanent weakening of the IAS and this may lead to incontinence of gas (6–9%), liquid (6–8%) and solid stool (1%) [5, 6].…”

Section: Introductionmentioning

confidence: 99%

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Bilateral versus unilateral botulinum toxin injections for chronic anal fissure: a randomised trial

et al. 2018

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BackgroundBotulinum toxin injected into the internal anal sphincter is used in the treatment of chronic anal fissure but there is no standardised technique for its administration. This randomised single centre trial compares bilateral (either side of fissure) to unilateral injection.MethodsParticipants were randomised to receive bilateral (50 + 50 units) or unilateral (100 units) Dysport® injections into the internal anal sphincter in an outpatient setting. Injection-related pain assessed by visual analogue scale was the primary outcome measure. Secondary outcomes were healing rate, fissure pain, incontinence, and global health scores.ResultsBetween October 2008 and April 2012, 100 patients with chronic anal fissure were randomised to receive bilateral or unilateral injections. Injection-related pain was comparable in both groups. There was no difference in healing rate. Initially, there was greater improvement in fissure pain in the bilateral group but at 1 year the unilateral group showed greater improvement. Cleveland Clinic Incontinence score was lower in the unilateral group in the early post-treatment period and global health assessment (EuroQol EQ-VAS) was higher in the unilateral group at 1 year.ConclusionsInjection-related pain was similar in bilateral and unilateral injection groups. Unilateral injection was as effective as bilateral injections in healing and improving fissure pain without any deterioration in continence.Electronic supplementary materialThe online version of this article (10.1007/s10151-018-1821-2) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

“…Although non-permanent, this causes a lowering of resting pressure for a temporary period allowing healing of the fissure. Success rates (65–75%) are significantly lower than those associated with surgical sphincterotomy [2, 10]. …”

Section: Introductionmentioning

confidence: 99%

Bilateral versus unilateral botulinum toxin injections for chronic anal fissure: a randomised trial

et al. 2018

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“…Medical management has a much-reduced incidence of the dreaded complication of faecal incontinence but has a higher recurrence rate (around 50% for medical management as compared to 3-6% for LIS) [23][24][25]. This recurrence rate is similar for both calcium channel blockers and nitrates.…”

Section: Pharmacological Managementmentioning

confidence: 99%

Fissure-In-ANO

Fahadullah¹,

Peirce²

2018

Proctological Diseases in Surgical Practice

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This chapter provides a summary of the aetiology, diagnosis, investigation and management of anal fissure. It gives an overview of clinical anatomy and pathophysiology related to anal fissure. Focusing on anal sphincter hypertonia as the key factor for anal fissure progression, the chapter draws attention to perpetuating factors that contribute to a vicious cycle of fissure non-healing and addresses management options for these factors. This chapter also looks at the way how different treatment options for anal fissure emerged over time and uses evidence-based medicine to compare these options."Fissure-in-ANO" concludes with summarising the treatment options and suggesting an algorithm for management of acute and chronic anal fissures.

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“…The change in practice was extensively studied and represented in recent reviews and meta-analyses. It has been confirmed that manual anal stretch had higher rate of incontinence and was not more effective than internal sphincterotomy [6][7][8].…”

Section: Introductionmentioning

confidence: 98%

The Long-term Effect of Standardized Anal Dilatation for Chronic Anal Fissure on Anal Continence

2021

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Purpose: For the past several decades, internal anal sphincterotomy has generally been considered to be the standard operation for an anal fissure. However, wound complications inherent in this operation forced surgeons to look for an alternative form of treatment. The aim of our study was to evaluate the long term outcome of anal dilatation for chronic anal fissure, especially possible negative impact on anal sphincter function.Methods: The study was approved by the Local Institutional Review Board and given a waiver of written consent. A phone call survey was undertaken among a group of consecutive patients who had an anal dilatation by standardized technique for chronic anal fissure for the period between 2000 -2016. The survey included medical, obstetrical and surgical-related data, Wexner fecal incontinence score, recurrence of the anal fissure and the need for additional medical intervention. 548 patients were identified after limitations of age, concomitant pathology and procedures that were applied to hospital computerized database. 85 patients (Group A) agreed to participate in the survey and 463 patients did not.Results: There were no differences between groups in demographic information and medical records data, therefore Group A may well represent a satisfactory sample of the whole group. The interval between the procedure and the survey was 6.8±2.7 years. The Wexner Incontinence Score was 0 in 94% of patients.Conclusions: Anal dilatation, performed in a systematic and standardized way, has successful outcome with no complications and has no clear long-term negative impact on anal sphincter function.

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A systematic review and meta-analysis of the treatment of anal fissure

Cited by 91 publications

References 147 publications

Bilateral versus unilateral botulinum toxin injections for chronic anal fissure: a randomised trial

Bilateral versus unilateral botulinum toxin injections for chronic anal fissure: a randomised trial

Fissure-In-ANO

The Long-term Effect of Standardized Anal Dilatation for Chronic Anal Fissure on Anal Continence

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