Anal fissure surgery: Difference between revisions
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{{Anal fissure}} | {{Anal fissure}} | ||
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==Overview== | ==Overview== | ||
Surgery is the option after trying the conservative and medical measures and its done in patients not responding to them, with chronic anal fissures and where fissures are complicated by fistulas and abscess. Lateral internal [[sphincterotomy]] is the procedure of choice. The complications of the surgery include fecal incontinence and therefore contraindicated in the patients having fecal incontinence. In these patients, anal advancement flap or [[Botulinum toxin]] is used. | |||
==Indications== | |||
*Surgery is usually the mainstay of treatment and done for patients with either: | |||
**Not responding to conservative measures | |||
**Chronic anal fissures | |||
**Fissures complicated by fistulas | |||
===Surgical | ==Surgery== | ||
===Surgical Sphincterotomy=== | |||
Surgical intervention may be required for persisting deep anal fissures unresponsive to the above conservative measures. Procedures include: | Surgical intervention may be required for persisting deep anal fissures unresponsive to the above conservative measures. Procedures include: | ||
* | *Lateral internal [[sphincterotomy]] is the gold standard surgical procedure. It increases fissure healing when compared to surgery like posterior [[sphincterotomy]], anal stretch and medical management.<ref name="pmid27041801">{{cite journal |vauthors=Schlichtemeier S, Engel A |title=Anal fissure |journal=Aust Prescr |volume=39 |issue=1 |pages=14–7 |year=2016 |pmid=27041801 |pmc=4816871 |doi=10.18773/austprescr.2016.007 |url=}}</ref><ref>http://www.surgwiki.com/wiki/Anal_and_perianal_disorders#Anal_fissure</ref><ref name="pmid25391392">{{cite journal |vauthors=Nelson RL |title=Anal fissure (chronic) |journal=BMJ Clin Evid |volume=2014 |issue= |pages= |year=2014 |pmid=25391392 |pmc=4229958 |doi= |url=}}</ref><ref>Jonas M, Scholefield JH. Anal fissure. In: Holzheimer RG, Mannick JA, editors. Surgical Treatment: Evidence-Based and Problem-Oriented. Munich: Zuckschwerdt; 2001. Available from: https://www.ncbi.nlm.nih.gov/books/NBK6878/</ref> | ||
* Anal dilation or stretching of the anal canal is no longer recommended because of the unacceptably high incidence of [[fecal incontinence]].<ref>{{cite journal |author=Kotlarewsky M, Freeman JB, Cameron W, Grimard LJ |title=Anal intraepithelial dysplasia and squamous carcinoma in immunosuppressed patients |journal=Canadian journal of surgery. Journal canadien de chirurgie |volume=44 |issue=6 |pages=450-4 |year=2001 |pmid=11764880 |doi= |url=http://www.cma.ca/multimedia/staticContent/HTML/N0/l2/cjs/vol-44/issue-6/pdf/pg450.pdf |format=PDF}}</ref> In addition, anal stretching can increase the rate of flatus incontinence.<ref>{{cite journal |author=Sadovsky R |title=Diagnosis and management of patients with anal fissures - Tips from Other Journals |journal=American Family Physician |year=2003 |month=1 April |volume=67 | issue=7 |pages=1608 |url=http://findarticles.com/p/articles/mi_m3225/is_7_67/ai_99410474 |format=Reprint}}</ref> | * Anal dilation or stretching of the anal canal is no longer recommended because of the unacceptably high incidence of [[fecal incontinence]].<ref>{{cite journal |author=Kotlarewsky M, Freeman JB, Cameron W, Grimard LJ |title=Anal intraepithelial dysplasia and squamous carcinoma in immunosuppressed patients |journal=Canadian journal of surgery. Journal canadien de chirurgie |volume=44 |issue=6 |pages=450-4 |year=2001 |pmid=11764880 |doi= |url=http://www.cma.ca/multimedia/staticContent/HTML/N0/l2/cjs/vol-44/issue-6/pdf/pg450.pdf |format=PDF}}</ref> In addition, anal stretching can increase the rate of flatus incontinence.<ref>{{cite journal |author=Sadovsky R |title=Diagnosis and management of patients with anal fissures - Tips from Other Journals |journal=American Family Physician |year=2003 |month=1 April |volume=67 | issue=7 |pages=1608 |url=http://findarticles.com/p/articles/mi_m3225/is_7_67/ai_99410474 |format=Reprint}}</ref> | ||
Despite the high success rate of these surgical procedures (~95%), there are potential side effects, which include | Despite the high success rate of these surgical procedures (~95%), there are potential side effects, which include risks from [[anesthesia]], [[infection]], and anal leakage ([[fecal incontinence]]). | ||
*In people who have a high risk of developing incontinence, the procedures done include:<ref name="pmid25391392">{{cite journal |vauthors=Nelson RL |title=Anal fissure (chronic) |journal=BMJ Clin Evid |volume=2014 |issue= |pages= |year=2014 |pmid=25391392 |pmc=4229958 |doi= |url=}}</ref> | |||
**Anal advancement flap | |||
**[[Botulinum toxin]] | |||
==Contraindications== | |||
*[[Fecal incontinence]] | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
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{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
[[Category:Medicine]] | |||
[[Category:Surgery]] | |||
[[Category:Gastroenterology]] | |||
[[Category:Up-To-Date]] | |||
Latest revision as of 20:24, 29 July 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Amandeep Singh M.D.[2]
Overview
Surgery is the option after trying the conservative and medical measures and its done in patients not responding to them, with chronic anal fissures and where fissures are complicated by fistulas and abscess. Lateral internal sphincterotomy is the procedure of choice. The complications of the surgery include fecal incontinence and therefore contraindicated in the patients having fecal incontinence. In these patients, anal advancement flap or Botulinum toxin is used.
Indications
- Surgery is usually the mainstay of treatment and done for patients with either:
- Not responding to conservative measures
- Chronic anal fissures
- Fissures complicated by fistulas
Surgery
Surgical Sphincterotomy
Surgical intervention may be required for persisting deep anal fissures unresponsive to the above conservative measures. Procedures include:
- Lateral internal sphincterotomy is the gold standard surgical procedure. It increases fissure healing when compared to surgery like posterior sphincterotomy, anal stretch and medical management.[1][2][3][4]
- Anal dilation or stretching of the anal canal is no longer recommended because of the unacceptably high incidence of fecal incontinence.[5] In addition, anal stretching can increase the rate of flatus incontinence.[6]
Despite the high success rate of these surgical procedures (~95%), there are potential side effects, which include risks from anesthesia, infection, and anal leakage (fecal incontinence).
- In people who have a high risk of developing incontinence, the procedures done include:[3]
- Anal advancement flap
- Botulinum toxin
Contraindications
References
- ↑ Schlichtemeier S, Engel A (2016). "Anal fissure". Aust Prescr. 39 (1): 14–7. doi:10.18773/austprescr.2016.007. PMC 4816871. PMID 27041801.
- ↑ http://www.surgwiki.com/wiki/Anal_and_perianal_disorders#Anal_fissure
- ↑ 3.0 3.1 Nelson RL (2014). "Anal fissure (chronic)". BMJ Clin Evid. 2014. PMC 4229958. PMID 25391392.
- ↑ Jonas M, Scholefield JH. Anal fissure. In: Holzheimer RG, Mannick JA, editors. Surgical Treatment: Evidence-Based and Problem-Oriented. Munich: Zuckschwerdt; 2001. Available from: https://www.ncbi.nlm.nih.gov/books/NBK6878/
- ↑ Kotlarewsky M, Freeman JB, Cameron W, Grimard LJ (2001). "Anal intraepithelial dysplasia and squamous carcinoma in immunosuppressed patients" (PDF). Canadian journal of surgery. Journal canadien de chirurgie. 44 (6): 450–4. PMID 11764880.
- ↑ Sadovsky R (2003). "Diagnosis and management of patients with anal fissures - Tips from Other Journals" (Reprint). American Family Physician. 67 (7): 1608. Unknown parameter
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