Concepts in pathogenesis and treatment of chronic anal fissure—a review of the literature

Utzig, M. J.

doi:10.1016/s0002-9270(03)00141-2

Cited by 34 publications

(45 citation statements)

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“…Surgical sphincterotomy, which is widely performed to provide symptomatic relief and healing, is highly effective, but can be associated with permanent complications. [1][2][3] Chemical denervation with type A botulinum neurotoxin has been proposed for the treatment of this condition without any risk of permanent internal anal sphincter injury. This is a versatile tool for targeted weakening of smooth muscle in the gastrointestinal tract and, compared with other indications, such as oesophageal achalasia, the effect is not limited to symptomatic improvement alone, but also produces healing in the majority of patients.…”

Section: Introductionmentioning

confidence: 99%

Botulinum neurotoxin to treat chronic anal fissure: results of a randomized ‘Botox vs. Dysport’ controlled trial

Brisinda¹,

Albanese

Cadeddu³

et al. 2004

Aliment Pharmacol Ther

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SUMMARYBackground: Botulinum neurotoxin induces healing in patients with idiopathic fissure. The optimal dosage is not well established. Aim: To compare the efficacy and tolerability of two different formulations of type A botulinum neurotoxin, and to provide more evidence with regard to the choice of dosage regimens. Methods: Symptomatic adults with chronic anal fissure were enrolled in a randomized study. The outcome of each group was evaluated clinically, and by comparing the pressure of the anal sphincters before and after treatment. Results: Fifty patients received injections of 50 units of Botox formulation (group I), and 50 patients received injections of 150 units of Dysport toxin (group II). One

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Section: Introductionmentioning

confidence: 99%

Botulinum neurotoxin to treat chronic anal fissure: results of a randomized ‘Botox vs. Dysport’ controlled trial

Brisinda¹,

Albanese

Cadeddu³

et al. 2004

Aliment Pharmacol Ther

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“…5 Relative vascular deficiency within both lower rectum and anal canal posterior wall could explain at least a part of the pathogenesis of chronic anal fissure. 9 Although this condition is rather common, 10 pathogenesis and aetiology are still incompletely understood. 11,12 This study, along with others, shows that blood flow to the posterior midline of the anus is potentially significantly deficient, even in the absence of anal fissure.…”

Section: Discussionmentioning

confidence: 99%

Assessment of haemorrhoidal artery network using Doppler‐guided haemorrhoidal artery ligation for haemorrhoids and pathogenesis implications

Trilling

Mancini

Reche

et al. 2019

ANZ Journal of Surgery

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Background Some authors, either with anatomical studies or Doppler laser flowmetric investigations have shown the blood flow to the posterior midline of the anus to be potentially deficient. This relative local ischaemia might explain pathogenesis of anal fissure, which is often located posteriorly. The aim of this study was to record the exact position of the distal branches of the superior rectal artery during Doppler‐guided haemorrhoidal artery ligation‐rectoanal repair (HAL‐RAR) procedures with special reference to posterior distribution of the arteries. Methods All consecutive patients with symptomatic haemorrhoids who were treated with the HAL‐RAR procedure between February 2008 and February 2014 in a single institution were included in the study. Number and position of Doppler‐guided ligations were prospectively collected. Pearson's chi‐squared test was used to compare artery locations. Results A total of 150 patients (75 women) with symptomatic haemorrhoids were included in the study. Median age was 53 years (range 23–83). A median of 10 ligations were placed per patient (range 3–18). A significantly lower number of cumulative arterial ligations was recorded in the posterior position (88 ligations overall, P = 0.025). Conclusions The number of distal branches of the superior rectal artery that have been localized by the Doppler‐guided HAL‐RAR technique is lower at the posterior midline than in the other segments of the lower rectum. This is another evidence of the vascular deficiency at the posterior pole of the anal canal that might explain the pathogenesis of the anal fissure.

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“…They may occur in connection with chronic inflammatory bowel disease, infectious disease like AIDS, other STD or tuberculosis, and tumors as well. 19,20 Among surgical treatments, lateral internal sphincterotomy is the treatment of first choice. 21 Among the conservative treatments, BTX-A is more effective than topical glyceryl trinitrate 0.2% ointment.…”

Section: Btx-a In Proctologymentioning

confidence: 99%

Botulinum toxin in dermatology – beyond wrinkles and sweat

Wollina

Konrad

Petersen

2005

J of Cosmetic Dermatology

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Botulinum toxin (BTX) types A and B have been used with success in cosmetic dermatology and hyperhidrosis treatment. The present review focuses on other uses of BTX in dermatology. Discussed in particular are the available data on BTX in inflammatory diseases, proctology, and some other indications. From studies in various types of eczema, it seems that BTX-A not only acts as a potent inhibitor of acetylcholine but also as an inhibitor of substance P and of glutamate as well. By those mechanisms, BTX-A may be antipruritic, which may help explain the benefits of BTX-A in lichen simplex and dyshidrotic hand eczema. In Hailey-Hailey disease, facial eccrine hidrocystomas, salivary fistulas, and intrinsic rhinitis, BTX-A blocks the secretion of sweat/saliva/mucus. BTX-A has important applications in proctology where it has become the most powerful nonsurgical therapy for anal fissures. In proctalgia fugax and after hemorrhoidectomy, BTX-A is analgesic. Current treatment applications of BTX-A and its limitations are reviewed in this paper.

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Concepts in pathogenesis and treatment of chronic anal fissure—a review of the literature

Cited by 34 publications

References 0 publications

Botulinum neurotoxin to treat chronic anal fissure: results of a randomized ‘Botox vs. Dysport’ controlled trial

Botulinum neurotoxin to treat chronic anal fissure: results of a randomized ‘Botox vs. Dysport’ controlled trial

Assessment of haemorrhoidal artery network using Doppler‐guided haemorrhoidal artery ligation for haemorrhoids and pathogenesis implications

Botulinum toxin in dermatology – beyond wrinkles and sweat

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