Management options for chronic anal fissure: a systematic review of randomised controlled trials

Boland, Patrick A; Kelly, Michael E.; Donlon, Noel E; Bolger, Jarlath; Larkin, John; Mehigan, Brian; McCormick, Paul

doi:10.1007/s00384-020-03699-4

Cited by 47 publications

(41 citation statements)

References 56 publications

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“…Pain seemed to be less in group A as shown in Table 3. The most common complaint reported by patients in both the groups was pain similar to our study Manoharan et al also documented identical results [18,19]. Overall complication occurrence rate was comparable in both groups.…”

Section: Discussionsupporting

confidence: 89%

Comparision of Postoperative Complications Associated with Closed Lateral Sphincterotomy and Fissurectomy with Dorsal Sphincterotomy in Chronic Anal Fissure

Bhatti¹,

Sohu²,

Bhellar³

et al. 2020

JPRI

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Background: Chronic anal fissure is clinical entity associated with significant pain and discomfort with bleeding. Different surgical options are being used nowadays to treat the ailment. Closed lateral sphincterotomy is being considered as gold standard treatment however, dorsal sphincterotomy with removal of chronic fissure is also used as treatment. Objectives: To compare effectiveness and patient satisfactions after both surgical procedures. To identify the common complications associated both surgical procedures. Methodology: The cross sectional conducted at Ghulam Muhammad Maher Medical College Sukkur from January 2016 to December 2019. Total 300 male patients with history of Chronic Anal Fissure for more than 6 months were included in the study. The patients were divided into two groups Group-A (150 patients) underwent lateral sphinterotomy whereas in Group-B (150 Patients) dorsal sphincterotomy with fissurectomy was performed. Randomization for grouping was performed by single blind sealed envelope technique. Patients with additional anorectal disease, haemorrhoids, HIV, HBV, HCV, and female patients were excluded from study. After performing surgery in both the groups follow-up was performed for 2 years and data was analyzed. Results: Mean age was 30.5 4±12.3 years, most common site of fissure among our study population was 6 O’ Clock (p-value=0.003), pain was seemed to be significant post-operative completion in both the groups however, both the treatment strategies appeared to be equally effective though patients in group B were more satisfied than group A. Conclusion: Both methods of surgeries seemed to be equally effective in treating the ailment. Recurrence after both surgeries was uncommon though pain was common postoperative complication.

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Section: Discussionsupporting

confidence: 89%

Comparision of Postoperative Complications Associated with Closed Lateral Sphincterotomy and Fissurectomy with Dorsal Sphincterotomy in Chronic Anal Fissure

Bhatti¹,

Sohu²,

Bhellar³

et al. 2020

JPRI

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“…Pain control always coincides with adequate healing. The effectiveness of medical therapies is also further lower in case of chronic fissure (50%) (25)(26)(27)(28)(29).…”

Section: Discussionmentioning

confidence: 99%

Scanner-Assisted CO2 Laser Fissurectomy: A Pilot Study

Cioppa

Linari

et al. 2021

Front. Surg.

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Introduction: Surgery for chronic anal fissure is challenging for every proctologist. Solving the pain by guaranteeing rapid and effective healing is the objective, but what is the price to pay today in functional terms? Though this result is nowadays partially achievable through interventions that include the execution of an internal sphincterotomy among the procedures, it is necessary to underline the high rate of patients who can present faecal incontinence. The aim of this study is to explore the effectiveness of scanner-assisted CO2 laser fissurectomy.Methods: From April 2021 to September 2021, all consecutive patients who affected by chronic anal fissure suitable for surgery, meeting the inclusion and exclusion criteria, were evaluated. All planned data were recorded before surgery, then at 24 h, 1 week, and 1 month follow-up. A scanner-assisted CO2 laser was used in this study to achieve a smooth and dried wound with a minimal tissue thermal damage, to ensure good postsurgical pain control, rapid and functional, elastic and stable healing, and to prevent potential relapses. Paracetamol 1 g every 8 h was prescribed for the first 24 h and then continued according to each patient's need. Ketorolac 15 mg was prescribed as rescue.Results: Mean pain intensity ≤3, considered as the principal endpoint, was recorded in 26 out of the 29 patients who enrolled in the study with a final success rate of 89.7% at 1-month follow-up. Pain and anal itching showed a statistically significant reduction while bleeding, burning, and maximum pain, and REALIS score showed a reduction too at the end of the follow-up period. Reepithelisation proved to be extremely fast and effective: 22 of 29 (75.9%) showed a complete healing and 5 showed a partial reepithelisation at 1-month follow-up.Discussion: Outcomes of this study showed that it is undoubtedly necessary to change the surgical approach in case of anal fissure. The internal sphincterotomy procedure must be most of all questioned, where the availability of cutting-edge technological tools must be avoided and offered only in selected cases. Scanner-assisted CO2 laser showed great results in terms of pain control and wound healing, secondary to an extremely precise ablation, vaporisation, and debridement procedures with minimal lateral thermal damage.

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“…According to the mentioned guidelines, BoNT may be used as a second-line therapy for fissure resistance to topical GTN or diltiazem. A systemic review of randomized controlled trials by P. A. Boland et al underlines that despite almost equal healing rates at 8 weeks between the BoNT and nitrate groups, 66.7% and 63.8%, respectively, and a slightly lower 52.3% healing rate for topical diltiazem, BoNT treatment demonstrated the highest recurrence rate at 41.7% and high fecal incontinence at 14.4%, compared to 10.0% for sphincterotomy and 1.9% for topical nitrates [ 36 ].…”

Section: Role Of Bont In Dermatologymentioning

confidence: 99%

Off-Label Use of Botulinum Toxin in Dermatology—Current State of the Art

2022

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Botulinum toxin (BoNT) is a neurotoxin produced by the Clostridium botulinum bacteria. Among seven different isoforms, only BoNT-A and BoNT-B are commercially used. Currently, botulinum toxin has been indicated by the U.S. Food and Drug Administration in several disorders, among others: chronic migraine, hyperhidrosis, urinary incontinence from detrusor overactivity, or cosmetics. However, there are numerous promising reports based on off-label BTX usage, indicating its potential effectiveness in other diseases, which remains unknown to many. Among them, dermatological conditions, such as rosacea, annal fissure, Raynaud phenomenon, hypertrophic scars and keloids, and also hidradenitis suppurativa, are currently being investigated. This article aims to provide a comprehensive update on the off-label use of botulinum toxin in dermatology, based on an analysis and summary of the published literature.

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Management options for chronic anal fissure: a systematic review of randomised controlled trials

Cited by 47 publications

References 56 publications

Comparision of Postoperative Complications Associated with Closed Lateral Sphincterotomy and Fissurectomy with Dorsal Sphincterotomy in Chronic Anal Fissure

Comparision of Postoperative Complications Associated with Closed Lateral Sphincterotomy and Fissurectomy with Dorsal Sphincterotomy in Chronic Anal Fissure

Scanner-Assisted CO2 Laser Fissurectomy: A Pilot Study

Off-Label Use of Botulinum Toxin in Dermatology—Current State of the Art

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