Document Detail

Changing patterns of treatment for chronic anal fissure.
MedLine Citation:
PMID:  9682643     Owner:  NLM     Status:  MEDLINE    
To assess changing patterns of treatment for chronic anal fissure, a retrospective analysis of treatment for chronic anal fissure within one hospital between January 1990 and December 1996 was undertaken. A total of 221 patients received treatment for a chronic anal fissure in this period, of whom 209 had a surgical procedure. Manual dilatation of the anus was performed in 21 patients (10%) and has not been performed since 1995. Lateral internal sphincterotomy was performed in 183 patients (88%) and continues to be the mainstay of treatment. Five female patients (2%) were identified as having a sphincter defect by anal manometry combined with endoanal ultrasound and were treated by an anal advancement flap. From 1996 onwards, 15 patients (7%) were treated by topical glyceryl trinitrate (GTN) paste as the first line of treatment. Of these patients, nine have experienced healing of their fissure, and three have had relief of pain without healing of the fissure. Three have gone on to have a lateral internal sphincterotomy. Lateral internal sphincterotomy remains the primary form of treatment for chronic anal fissure. GTN cream has increasingly been offered as preliminary treatment over the last 12 months. Perioperative use of endoanal ultrasound allowed identification of patients who may be at high risk of postoperative incontinence from a sphincterotomy. An anal advancement flap has been used as an alternative surgical approach for these patients.
R Farouk; J Gunn; G S Duthie
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Annals of the Royal College of Surgeons of England     Volume:  80     ISSN:  0035-8843     ISO Abbreviation:  Ann R Coll Surg Engl     Publication Date:  1998 May 
Date Detail:
Created Date:  1998-08-04     Completed Date:  1998-08-04     Revised Date:  2009-11-18    
Medline Journal Info:
Nlm Unique ID:  7506860     Medline TA:  Ann R Coll Surg Engl     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  194-6     Citation Subset:  IM    
Academic Surgical Unit, University of Hull, Castle Hill Hospital, Kingston upon Hull.
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MeSH Terms
Chronic Disease
Fissure in Ano / drug therapy,  surgery*,  therapy
Middle Aged
Nitroglycerin / therapeutic use
Retrospective Studies
Surgical Flaps
Vasodilator Agents / therapeutic use
Reg. No./Substance:
0/Vasodilator Agents; 55-63-0/Nitroglycerin
Comment In:
Ann R Coll Surg Engl. 1999 Mar;81(2):141   [PMID:  10364978 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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