Surgical Sphincter Saving Approach and Topical Nifedipine for Chronic Anal Fissure with Hypertonic Internal Anal Sphincter

D’Orazio, Beatrice; Sciumè, C; Famà, Fausto; Bonventre, Sebastiano; Martorana, Guido; Corbo, Giovanni; Calí, Dario; Terranova, Gloria; Vita, Gaetano Di; Geraci, Girolamo

doi:10.21614/chirurgia.115.5.585

Cited by 5 publications

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“…Healing of fissures in other studies reported, showed 97-100% with dierent follow-up periods. 15,16 The smaller dierence reported regarding the healing of fissures is due to the dierence in follow-up period that is the shorter period for the follow-up in our study. This study also shows that the bleeding per rectum ceased in 97.1% at the 6 th week postoperatively with the overall satisfaction of the patients being 95% which coincides with other studies.…”

Section: Discussionmentioning

confidence: 65%

Frequency of Post-Operative Fecal Incontinence and Healing Rate in Patients with Open and Closed Lateral Internal Anal Sphincterotomy

Shah¹,

Usman²,

Alam³

et al. 2022

J Gandhara Med Dent Sci

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OBJECTIVES This study aims to compare the frequency of fecal incontinence and healing rate in patients treated with Open Internal Anal Sphincterotomy (OIAS) and Closed Lateral Internal Anal Sphincterotomy (CLIAS). METHODOLOGY This randomized control trial was carried out in the Department of Surgery Hayatabad Medical Complex, Peshawar Pakistan from Feb 2019 to Feb 2020. Eighty-four patients were assigned to the open method in Group B while eighty-four patients were allocated to the closed method in Group A (using blade 11) through the randomized control trial method. Fecal incontinence and healing rate were observed on the 7 th postoperative day. SPSS 23.0 software was used to analyse the data. RESULTS In group A out of a total of 84 patients, 96% of patients were in category A, 4% of patients were in category B, and no patients were in categories C and D. In group B out of 84 patients, 96% of patients were in category A while 4% patients were in category B and no patients were in category C and D. The total faecal incontinence in Group B (open method) was 21% while total fecal incontinence in Group A (closed method) was only 4% that is a clear dierence between the two groups. In group A (closed method) out of 84 patients, 2 patients (2.38 %) showed delayed healing while 82 patients (97.61 %) showed normal healing. In group B (open method) 7.4% of patients showed delayed healing with a signicance p level of 0.04 while 92.85 showed normal healing. CONCLUSION Fecal incontinence was less in closed Lateral Anal Sphincterotomy due to the use of blade 11 while it was higher in open internal anal sphincterotomy. Similarly, the healing rate was signicantly higher in the closed method while delayed healing was seen in the open method.

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Section: Discussionmentioning

confidence: 65%

Frequency of Post-Operative Fecal Incontinence and Healing Rate in Patients with Open and Closed Lateral Internal Anal Sphincterotomy

Shah¹,

Usman²,

Alam³

et al. 2022

J Gandhara Med Dent Sci

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“…Another advantage of using a flap may be represented by the boosting effect on cutaneous circumference of the anal canal, which reduces the risk of splitting. Lastly, the employment of drugs enables the reduction of IAS tone and leads to an improvement in the blood supply of the naked area[ 37 - 39 ].…”

Section: Discussionmentioning

confidence: 99%

“…The sentinel skin tags, and hypertrophied anal papilla located at the dentate line were excised, if present; the tissue at the base of the fissure was curetted until clean IAS muscle fibres were reached. Technical details concerning the surgical procedure have already been widely explained in a previous work from our group[ 9 , 10 ].…”

Section: Methodsmentioning

confidence: 99%

Botulinum toxin associated with fissurectomy and anoplasty for hypertonic chronic anal fissure: A case-control study

D’Orazio¹,

Geraci²,

Famà³

et al. 2021

WJCC

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BACKGROUND Lateral internal sphincterotomy is still the approach of choice for the treatment of chronic anal fissure (CAF) with internal anal sphincter (IAS) hypertonia, but it is burdened by high-risk postoperative faecal incontinence (FI). Sphincter saving procedures have recently been reconsidered as treatments to overcome this risk. The most employed procedure is fissurectomy with anoplasty, eventually associated with pharmacological sphincterotomy. AIM To evaluate whether fissurectomy and anoplasty with botulinum toxin injection improves the results of fissurectomy and anoplasty alone. METHODS We conducted a case-control study involving 30 male patients affected by CAF with hypertonic IAS who underwent fissurectomy and anoplasty with V-Y cutaneous flap advancement. The patients were divided into two groups: Those in group I underwent surgery alone, and those in group II underwent surgery and a botulinum toxin injection directly into the IAS. They were followed up for at least 2 years. The goals were to achieve complete healing of the patient and to assess the FI and recurrence rate along with manometry parameters. RESULTS The intensity and duration of post-defecatory pain decreased significantly in both groups of patients starting with the first defecation, and this reduction was higher in group II. Forty days after surgery, we achieved complete wound healing in all the patients in group II but only in 80% of the patients in group I ( P < 0.032). We recorded 2 cases of recurrence, one in each group, and both healed with conservative therapy. We recorded one temporary and low-grade postoperative case of “ de novo ” FI. Manometry parameters reverted to the normal range earlier for group II patients. CONCLUSION The injection of botulinum toxin A in association with fissurectomy and anoplasty with a V-Y advancement flap improves the results of surgery alone in patients affected by CAF with IAS hypertonia.

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“…The patients with hypertonic IAS were treated with intraoperative local injection of 30 U.I. of botulinum toxin A (Botox, Allergan Westport, Ireland) [14] or with local administration of post-operative nifedipine and lidocaine for 15 days after surgery (Antrolin ® ) [15]. Before surgery, all patients received a small volume of phosphate-saline enema.…”

Section: Methodsmentioning

confidence: 99%

Safety and effectiveness of saving sphincter procedure in the treatment of chronic anal fissure in female patients

et al. 2021

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Introduction Lateral internal sphincterotomy (LIS) is still the approach of choice for the treatment of chronic anal fissure (CAF) regardless to the internal anal sphincter tone but it is burdened by high risk post-operative faecal incontinence (FI). In female patient there are some anatomical and functional differences of the sphinteric system which make them more at risk of FI and vaginal birth could cause sphinteric lesions affecting the anal continence function. The aim of our study is to evaluate the results of saving sphincter procedure as treatment for female patients affected by CAF. Methods We studied 110 female patients affected by CAF undergone fissurectomy and anoplasty with V–Y cutaneous flap advancement associating pharmacological sphincterotomy in patients with hypertonic IAS. The follow up was at least for 2 years. The goals were patient’s complete healing, the evaluation of FI, recurrence rate and manometry parameters. Results All wounds healed within 40 days after surgery. We recorded 8 cases of recurrences 6 healed with medical therapy and 2 with dilatation. We recorded 2 “de novo” temporary and low grade post-operative cases of FI. Post-operative value of MRP were unmodified in patient with normotonic IAS but significantly lower at 12 months follow up as compared with the pre-operative ones in patients with hypertonic IAS; after 24 months from surgery MRP values were within the normal range. Conclusion The fissurectomy and anoplasty with V–Y cutaneous flap alone or in association with a pharmacological sphincterotomy in patients with hypertonic IAS may represent an effective approach for the treatment of CAF in female patients.

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Surgical Sphincter Saving Approach and Topical Nifedipine for Chronic Anal Fissure with Hypertonic Internal Anal Sphincter

Cited by 5 publications

References 0 publications

Frequency of Post-Operative Fecal Incontinence and Healing Rate in Patients with Open and Closed Lateral Internal Anal Sphincterotomy

Frequency of Post-Operative Fecal Incontinence and Healing Rate in Patients with Open and Closed Lateral Internal Anal Sphincterotomy

Botulinum toxin associated with fissurectomy and anoplasty for hypertonic chronic anal fissure: A case-control study

Safety and effectiveness of saving sphincter procedure in the treatment of chronic anal fissure in female patients

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