An evidence-based treatment algorithm for anal fissure

Lund, Jonathan N.; Nyström, Per‐Olof; Coremans, Georges; Herold, Alexander; Karaïtianos, I; Spyrou, Maria A.; Schouten, W. R.; Sebastián, Antonio Arroyo; Pescatori, Mario

doi:10.1007/s10151-006-0276-z

Cited by 40 publications

(19 citation statements)

References 21 publications

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“…At least two recent guidelines by the American Society of Colon and Rectal Surgeons and the European Society of Coloproctology defined LIS as the surgical treatment of choice for refractory anal fissures [12,13]. Although LIS has a cure rate of over 95%, recent studies have reported the risk of incontinence of feces or flatus after this procedure.…”

Section: Discussionmentioning

confidence: 99%

Mild and Severe Anal Incontinence after Lateral Internal Sphincterotomy: Risk Factors, Postoperative Anatomical Findings and Quality of Life

et al. 2011

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Aim: This study aims to evaluate the risk factors for incontinence after lateral internal sphincterotomy (LIS) and assess quality of life in different levels of incontinence. Methods: All consecutive patients (n = 253) with chronic anal fissure who underwent LIS between 2003 and 2006 were retrospectively reviewed. All patients were questioned for possible anal incontinence according to the Wexner Incontinence Score (WIS). Demographics, vaginal delivery history, additional procedures and surgeon’s experience were evaluated as risk factors. Endoanal ultrasound (EUS) was performed in incontinent patients to assess the thickness of the remaining internal sphincter and to evaluate any injury in the external sphincter. Quality of life was questioned with SF-36. Results: Twenty-eight (11.7%) patients suffered from incontinence (mean WIS = 3.6 ± 2.5). The search for a risk factor was unsuccessful when continent and incontinent groups were compared. In subgroup analyses, patients were found to be suffering from mild (WIS <5, n = 19) or severe (WIS >5, n = 9) incontinence. Vaginal delivery history was found more often in the severely incontinent subgroup than in the continent group (p < 0.05). Also, vaginal delivery history and the additional procedures were more frequently observed in the severely incontinent subgroup than in the mildly incontinent subgroup. EUS did not find any external sphincter injury in these cases. WIS had negative correlations with the physical and mental component scores of SF-36. Conclusion: In our opinion, the threat for incontinence is unpredictable; however, vaginal delivery history may increase the risk of severe incontinence.

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Section: Discussionmentioning

confidence: 99%

Mild and Severe Anal Incontinence after Lateral Internal Sphincterotomy: Risk Factors, Postoperative Anatomical Findings and Quality of Life

et al. 2011

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“…Evidence-based algorithms for the treatment of anal fissures were developed in 2006 by clinicians from across Europe [184]. The algorithms are for the treatment of fissures in both primary and secondary care (Fig.…”

Section: Current Guidelinesmentioning

confidence: 99%

“…However, those patients suffering persistent but asymptomatic fis- Fig. 2a, b Algorithm for the treatment of anal fissure (taken from [184]). a Initial presentation (primary care).…”

Section: Current Guidelinesmentioning

confidence: 99%

A review of chronic anal fissure management

Collins

Lund

2007

Tech Coloproctol

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Anal fissure management has rapidly progressed in the last 15 years as our understanding of fissure pathophysiology has developed. All methods of treatment aim to reduce the anal sphincter spasm associated with chronic anal fissures. Surgical techniques have been used for over 100 years with success. Lateral internal sphincterotomy remains the surgical treatment of choice for many practitioners. Postoperative impairment of continence remains controversial. Recently, less invasive methods of treatment have been explored. Topical nitrates, calcium channel blockers and botulinum toxin are established treatments. These and other non-surgical treatments are described in this review. Various guidelines and treatment algorithms for anal fissure are also discussed.

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“…But, for the majority of patients, this treatment makes it possible to avoid irreversible resection of the internal anal sphincter and the postoperative consequences. Since the introduction of topical nitrates, the number of surgical interventions performed for anal fissure has fallen by 72% in England and 61% in Scotland [4].…”

Section: Dear Sirmentioning

confidence: 99%