Topical Nifedipine With Lidocaine Ointment vs. Active Control for Treatment of Chronic Anal Fissure

Perrotti, Pasquale; Bove, Vincenzo; Antropoli, Carmine; Molino, D; Antropoli, Massimo; Balzano, A.; Stefano, Guglielmo de; Attena, Francesco

doi:10.1007/s10350-004-6452-1

Cited by 100 publications

(47 citation statements)

References 46 publications

(71 reference statements)

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“…[24] [25] Topical CCBs have been shown to be better than both lignocaine ointment and hydrocortisone cream, with up to 95% remission in two studies. [25] [26] Compared with GTN, topical application of CCBs has been shown to be equally effective with fewer side effects in various prospective, randomized studies. The principal side effect is mild headache, seen in up to 25% of patients.…”

Section: Methodsmentioning

confidence: 99%

“…The principal side effect is mild headache, seen in up to 25% of patients. [26] Topical nifedipine has also been compared with lateral internal sphincterotomy with healing rates of 97% and 100% at 8 weeks. Long-term follow up at 19 months showed healing rates of 93% and 100% for the nifedipine and lateral internal sphincterotomy (LIS) groups, respectively.…”

Section: Methodsmentioning

confidence: 99%

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Anal Fissure Revisited : A Systematic Review

Singh¹,

Chandrakar²,

Agrawal³

et al. 2015

jemds

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Anal fissure is one of the most common anorectal problems. Anal fissure is largely associated with high anal sphincter pressures and most treatment options are based on reducing anal pressures. There are many options to treat chronic fissures in ano. Some of them are non-surgical while the others are surgical. The efficacy claimed by each of the prevalent method is very high but the inconsistencies and contraindications are equally strong. To date, lateral sphincterotomy has been favoured by most of the proctologists, because it is the least extensive surgical procedure and is offering a long lasting relief in sphincter spasm. Various management technique are reviewed in this article along with Advancement flap for anterior fissure and a new method combining the age-old technique of Lord's manual dilatation followed by radio surgery is also highlighted along with their complications. The addition of radio surgery is found useful for refreshing the edges of the fissure and to tackle pathologies namely sentinel pile, small internal piles or hypertrophied anal papillae often found associated with chronic fissures. Revisiting the trends of treatment of chronic anal fissures, the most preferred options are the manual dilatation with radio surgery and the subcutaneous lateral anal sphincterotomy. Both methods are easy to perform, have negligible complications and no special setup is needed, except the radio surgical unit, in case of the first procedure.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Anal Fissure Revisited : A Systematic Review

Singh¹,

Chandrakar²,

Agrawal³

et al. 2015

jemds

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show abstract

“…Side effects of local application of diltiazem, such as perianal dermatitis and headaches, are rare. Nifedipine and diltiazem have an effect that is comparable to GTN, but cause fewer side effects with local application [1,23,24,25,26]. Moreover, diltiazem heals 48–75% of GTN ointment-resistant CAFs [27, 28].…”

Section: Discussionmentioning

confidence: 99%

Botulinum Toxin A Injection in ISDN Ointment-Resistant Chronic Anal Fissures

Witte

Klaase

2007

Dig Surg

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Background: In the treatment of chronic anal fissures (CAFs), surgical sphincterotomy is more commonly being replaced by chemical sphincterotomy. After the good results of our pilot study including 32 patients, we now describe the effect of botulinum toxin A (BT-A) in a consecutive series of 100 patients with isosorbide dinitrate (ISDN) ointment-resistant CAFs. Methods: From October 2002 until August 2005, 100 patients (52 males, 48 females) with a median age of 45 (20–79) years were treated with an injection of 40–100 IU BT-A (Dysport®, Ipsen, The Netherlands) in the internal anal sphincter. Results: After a median follow-up of 10 (4–38) months, 77 of the 100 CAFs (77%) were cured. 20 patients were given a second injection, 1 a third and 1 a fourth injection. In 11 patients a fissure recurred (14%). In 1 patient (1%) there was temporary incontinence due to flatus. Conclusion: With an early response rate of 77% and an overall success rate of 66%, BT-A injections appear to be effective in patients with ISDN ointment-resistant CAFs if initial non-responders are retreated. These results are in concordance with the results of our pilot study. It is a simple technique with little or no side effects, that does not compromise future treatments. Its place in the first-line treatment of CAFs should be investigated further.

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“…1Y4 Furthermore, internal anal spasm and hypertonia of the anal canal are associated with decreased mucosal blood flow and poor healing due to impairment of the microcirculation. 5,6 Previous attempts to reduce internal sphincter spasm by means of internal anal sphincterotomy or anal dilatation did not significantly reduce postoperative pain. 3,4,7,8 Nitric oxide has been shown to mediate internal anal sphincter relaxation.…”

mentioning

confidence: 99%