Anal fissure surgery
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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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