ANAL FISSURE
Section snippets
PATHOGENESIS
The pathogenesis of chronic anal fissure is poorly understood. Surgical dogma is that the passage of a hard stool traumatizes the anal mucosa. This is a plausible initiating factor but does not explain why only 1 in 4 patients reports constipation, and the onset of symptoms follows a bout of diarrhea in 4% to 7 % of instances.48, 61, 76 There may be a dietary association because individuals consuming a diet low in fiber appear to be at increased risk of developing anal fissures.41 Alternative
TREATMENT
Treatment for anal fissures is described in Table 1 and Figure 1.
SUMMARY
Anal fissure is a common condition, and although most are short-lived and heal spontaneously, those that persist and require intervention cause considerable morbidity in an otherwise healthy young population. Traditionally, lateral internal sphincterotomy was the gold standard treatment for chronic fissures, but this procedure is associated with a risk of incontinence to some degree in 30% of patients. The discovery of pharmacologic agents that effectively cause a chemical sphincterotomy and
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Real world outcomes of lateral internal sphincterotomy vs botulinum toxin for the management of chronic anal fissures
2022, Asian Journal of SurgeryCitation Excerpt :There have been no reported differences in outcome for either approach.5,21 More recently, there has been a move to extend the sphincterotomy incision only to the superior extent of the fissure, as this improves postoperative incontinence rates without compromising efficacy.4,22,23 BT injection on the other hand is still in its relative infancy and there remains significant variability in the implementation technique.
Are we following an algorithm for managing chronic anal fissure? A completed audit cycle
2016, Annals of Medicine and SurgeryAnal fissure and stenosis
2013, Gastroenterology Clinics of North AmericaCitation Excerpt :Anterior midline AFs are most commonly found in women.14 About 3% to 10% of AFs occur in the postpartum period, and these are often in the anterior midline.10,15–20 Primary AFs are idiopathic, usually anterior or posterior, and are not caused by underlying disease.
A LOOK AT HOW SURGERY AND LOCAL TREATMENT WITH DILTIAZEM FOR CHRONIC ANAL FISSURE AT SAMARRA GENERAL HOSPITAL
2023, Revista Iberoamericana de Psicologia del Ejercicio y el Deporte
Address reprint requests to John H. Scholefield, FRCS, ChM Section of Surgery University Hospital Queen's Medical Centre E Floor, West Block Nottingham NG7 2UH UK