Anal fissure surgery: Difference between revisions
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===Surgical Sphincterotomy=== | ===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 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> | *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 risks from [[anesthesia]], [[infection]], and anal leakage ([[fecal incontinence]]). | 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]]). | ||
==Contraindications== | ==Contraindications== | ||
*Fecal incontinence | *Fecal incontinence |
Revision as of 16:32, 30 January 2018
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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
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).
Contraindications
- Fecal incontinence
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
- ↑ 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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