A chronic anal fissure is a common perianal condition.This review aims to evaluate both existing and new therapies in the treatment of chronic fissures.Pharmacological therapies such as glyceryl trinitrate(GTN),Diltia...A chronic anal fissure is a common perianal condition.This review aims to evaluate both existing and new therapies in the treatment of chronic fissures.Pharmacological therapies such as glyceryl trinitrate(GTN),Diltiazem ointment and Botulinum toxin provide a relatively non-invasive option,but with higher recurrence rates.Lateral sphincterotomy remains the gold standard for treatment.Anal dilatation has no role in treatment.New therapies include perineal support devices,Gonyautoxin injection,fissurectomy,fissurotomy,sphincterolysis,and flap procedures.Further research is required comparing these new therapies with existing established therapies.This paper recommends initial pharmacological therapy with GTN or Diltiazem ointment with Botulinum toxin as a possible second line pharmacological therapy.Perineal support may offer a new dimension in improving healing rates.Lateral sphincterotomy should be offered if pharmacological therapy fails.New therapies are not suitable as first line treatments,though they can be considered if conventional treatment fails.展开更多
<b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:Verdana;"></span><b> </b><span style="font-family:Verdan...<b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:Verdana;"></span><b> </b><span style="font-family:Verdana;">Chronic anal fissure is a benign disorder which is associated with considerable discomfort. </span><span style="font-family:Verdana;"><b></b></span><b><b><span style="font-family:Verdana;">Aim of the Work:</span></b><span style="font-family:;" "=""><span style="font-family:Verdana;"></span></span></b><b> </b><span style="font-family:;" "=""><span style="font-family:Verdana;">The aim of this study was to compare the post-operative results of open and closed internal lateral sphincterotomies in the short and medium term.</span><b> </b></span><span style="font-family:Verdana;"><b></b></span><b><b><span style="font-family:Verdana;">Patient and Methods:</span></b><span style="font-family:;" "=""><span style="font-family:Verdana;"></span></span></b><b> </b><span style="font-family:Verdana;">We carried out a prospective randomized comparative study in the digestive and visceral surgery departments of Central Hospital of Yaounde over a period of 15</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">months. Patients were evaluated for each technique by several variables, including duration of surgery, post-operative pain, recurrence, surgical wound infection, gas and/or stool incontinence, and healing time with follow-up up to 12</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">months postoperatively.</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;"><b></b></span><b><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:;" "=""><span style="font-family:Verdana;"></span></span></b><b> </b><span style="font-family:Verdana;">A total of 63 patients underwent surgery within them we had 32 open lateral internal sphincterotom</span><span style="font-family:Verdana;">ies</span><span style="font-family:Verdana;"> (group 1) and 31 closed lateral internal sphincterotom展开更多
Chronic anal fissure(CAF)is a painful tear or crack which occurs in the anoderm.The optimal algorithm of therapy for CAF is still debated.Lateral internal sphincterotomy(LIS)is a surgical treatment,considered as the&#...Chronic anal fissure(CAF)is a painful tear or crack which occurs in the anoderm.The optimal algorithm of therapy for CAF is still debated.Lateral internal sphincterotomy(LIS)is a surgical treatment,considered as the'gold standard'therapy for CAF.It relieves CAF symptoms with a high rate of healing.Chemical sphincterotomy(CS)with nitrates,calcium blockers or botulinum toxin(BTX)is safe,with the rapid relief of pain,mild sideeffects and no risk of surgery or anesthesia,but is a statistically less effective therapy for CAF than LIS.This article considers if aggressive treatment should only be offered to patients who fail pharmacological sphincterotomy.Aspects of anal fissure etiology,epidemiology and pathophysiology are considered with their meaning for further management of CAF.A molecular model of chemical interdependence significant for the chemistry of CAF healing is examined.Its application may influence the development of optimal therapy for CAF.BTX is currently considered the most effective type of CS and discussion in this article scrutinizes this method specifically.Although the effectiveness of BTXvs LIS has been discussed,the essential focus of the article concerns identifying the best therapy application for anal fissure.Elements are presented which may help us to predict CAF healing.They provide rationale for the expansion of the CAF therapy algorithm.Ethical and economic factors are also considered in brief.As long as the patient is willing to accept the potential risk of fecal incontinence,we have grounds for the'gold standard'(LIS)as the first-line treatment for CAF.The author concludes that,when the diagnosis of the anal fissure is established,CS should be considered for both ethical and economic reasons.He is convinced that a greater understanding and recognition of benign anal disorders by the GP and a proactive involvement at the point of initial diagnosis would facilitate the consideration of CS at an earlier,more practical stage with improved outcomes for the patient.展开更多
目的：探讨改良肛裂切口扩创术在陈旧性肛裂治疗中的作用。方法将2009年1月～2012年12月广东省河源市人民医院94例陈旧性肛裂I期及I I期患者均分为对照组与观察组（n=47）。对照组采用常规肛裂侧位内括约肌切断手术进行手术，观察组采...目的：探讨改良肛裂切口扩创术在陈旧性肛裂治疗中的作用。方法将2009年1月～2012年12月广东省河源市人民医院94例陈旧性肛裂I期及I I期患者均分为对照组与观察组（n=47）。对照组采用常规肛裂侧位内括约肌切断手术进行手术，观察组采用改良肛裂切开扩创术进行手术，术后均进行药物辅助治疗，观察2组患者的分期治愈情况、疼痛比较、创面愈合时间及术后肛门功能。结果观察组治愈率为88.7%，显著高于对照组的71.7%（χ2=4.810，P=0.028）；观察组和对照组术后疼痛评分分别为（4.67±2.64 vs 5.09±2.79）、创面愈合时间（15.3±2.09）d vs （16.8±2.34）d，相比较差异无统计学意义；术后1年随访均未发现肛门不完全性失禁以及肛门狭窄等不良并发症。结论改良肛裂切口扩创在陈旧性肛裂治疗中疗效确切，拥有更高的治愈率，值得临床推广应用。展开更多
文摘A chronic anal fissure is a common perianal condition.This review aims to evaluate both existing and new therapies in the treatment of chronic fissures.Pharmacological therapies such as glyceryl trinitrate(GTN),Diltiazem ointment and Botulinum toxin provide a relatively non-invasive option,but with higher recurrence rates.Lateral sphincterotomy remains the gold standard for treatment.Anal dilatation has no role in treatment.New therapies include perineal support devices,Gonyautoxin injection,fissurectomy,fissurotomy,sphincterolysis,and flap procedures.Further research is required comparing these new therapies with existing established therapies.This paper recommends initial pharmacological therapy with GTN or Diltiazem ointment with Botulinum toxin as a possible second line pharmacological therapy.Perineal support may offer a new dimension in improving healing rates.Lateral sphincterotomy should be offered if pharmacological therapy fails.New therapies are not suitable as first line treatments,though they can be considered if conventional treatment fails.
文摘<b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:Verdana;"></span><b> </b><span style="font-family:Verdana;">Chronic anal fissure is a benign disorder which is associated with considerable discomfort. </span><span style="font-family:Verdana;"><b></b></span><b><b><span style="font-family:Verdana;">Aim of the Work:</span></b><span style="font-family:;" "=""><span style="font-family:Verdana;"></span></span></b><b> </b><span style="font-family:;" "=""><span style="font-family:Verdana;">The aim of this study was to compare the post-operative results of open and closed internal lateral sphincterotomies in the short and medium term.</span><b> </b></span><span style="font-family:Verdana;"><b></b></span><b><b><span style="font-family:Verdana;">Patient and Methods:</span></b><span style="font-family:;" "=""><span style="font-family:Verdana;"></span></span></b><b> </b><span style="font-family:Verdana;">We carried out a prospective randomized comparative study in the digestive and visceral surgery departments of Central Hospital of Yaounde over a period of 15</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">months. Patients were evaluated for each technique by several variables, including duration of surgery, post-operative pain, recurrence, surgical wound infection, gas and/or stool incontinence, and healing time with follow-up up to 12</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">months postoperatively.</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;"><b></b></span><b><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:;" "=""><span style="font-family:Verdana;"></span></span></b><b> </b><span style="font-family:Verdana;">A total of 63 patients underwent surgery within them we had 32 open lateral internal sphincterotom</span><span style="font-family:Verdana;">ies</span><span style="font-family:Verdana;"> (group 1) and 31 closed lateral internal sphincterotom
文摘Chronic anal fissure(CAF)is a painful tear or crack which occurs in the anoderm.The optimal algorithm of therapy for CAF is still debated.Lateral internal sphincterotomy(LIS)is a surgical treatment,considered as the'gold standard'therapy for CAF.It relieves CAF symptoms with a high rate of healing.Chemical sphincterotomy(CS)with nitrates,calcium blockers or botulinum toxin(BTX)is safe,with the rapid relief of pain,mild sideeffects and no risk of surgery or anesthesia,but is a statistically less effective therapy for CAF than LIS.This article considers if aggressive treatment should only be offered to patients who fail pharmacological sphincterotomy.Aspects of anal fissure etiology,epidemiology and pathophysiology are considered with their meaning for further management of CAF.A molecular model of chemical interdependence significant for the chemistry of CAF healing is examined.Its application may influence the development of optimal therapy for CAF.BTX is currently considered the most effective type of CS and discussion in this article scrutinizes this method specifically.Although the effectiveness of BTXvs LIS has been discussed,the essential focus of the article concerns identifying the best therapy application for anal fissure.Elements are presented which may help us to predict CAF healing.They provide rationale for the expansion of the CAF therapy algorithm.Ethical and economic factors are also considered in brief.As long as the patient is willing to accept the potential risk of fecal incontinence,we have grounds for the'gold standard'(LIS)as the first-line treatment for CAF.The author concludes that,when the diagnosis of the anal fissure is established,CS should be considered for both ethical and economic reasons.He is convinced that a greater understanding and recognition of benign anal disorders by the GP and a proactive involvement at the point of initial diagnosis would facilitate the consideration of CS at an earlier,more practical stage with improved outcomes for the patient.
文摘目的：探讨改良肛裂切口扩创术在陈旧性肛裂治疗中的作用。方法将2009年1月～2012年12月广东省河源市人民医院94例陈旧性肛裂I期及I I期患者均分为对照组与观察组（n=47）。对照组采用常规肛裂侧位内括约肌切断手术进行手术，观察组采用改良肛裂切开扩创术进行手术，术后均进行药物辅助治疗，观察2组患者的分期治愈情况、疼痛比较、创面愈合时间及术后肛门功能。结果观察组治愈率为88.7%，显著高于对照组的71.7%（χ2=4.810，P=0.028）；观察组和对照组术后疼痛评分分别为（4.67±2.64 vs 5.09±2.79）、创面愈合时间（15.3±2.09）d vs （16.8±2.34）d，相比较差异无统计学意义；术后1年随访均未发现肛门不完全性失禁以及肛门狭窄等不良并发症。结论改良肛裂切口扩创在陈旧性肛裂治疗中疗效确切，拥有更高的治愈率，值得临床推广应用。
