| Reasons for failure of glyceryl trinitrate treatment of chronic fissure-in-ano: a multivariate analysis. | |
| | |
MedLine Citation:
|
PMID: 11391149 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
PURPOSE: Although glyceryl trinitrate ointment has become the first-line treatment for chronic anal fissure, healing rates are lower than after lateral internal sphincterotomy. The purpose of this study was to identify which factors are associated with treatment failure of glyceryl trinitrate ointment. METHODS: All patients who presented with chronic anal fissure from March 1997 to November 1998 were treated with 0.2 percent glyceryl trinitrate ointment. They were prospectively evaluated until healing or lateral internal sphincterotomy occurred, and long-term follow-up was obtained by standardized telephone questionnaire. A Cox model multivariate analysis was used with seven variables to determine significant factors related to healing. RESULTS: Sixty-four patients (42 men and 22 women; mean age, 37.5 years) with chronic fissure-in-ano were treated with 0.2 percent glyceryl trinitrate ointment. Sentinel piles were observed in 19 patients (29.7 percent). Twenty-six patients (40.6 percent) were healed initially, but 12 (46.2 percent) experienced recurrence. Mean follow-up time was 15.6 (+/-5.5) months. Twenty-nine patients (45.3 percent) had known risk factors for anal fissure, including constipation (n = 21; 32.8 percent), recent childbirth (n = 6; 9.3 percent), colonoscopy (n = 1; 1.6 percent), and anoreceptive intercourse (n = 1; 1.6 percent). Fissures were significantly less likely to heal initially (P < 0.05), more likely to recur (P < 0.05), and more likely to remain unhealed in the long term (P < 0.05) in the presence of a sentinel pile. Fissures with a history of more than six months were less likely to heal initially (P < 0.05). CONCLUSION: The presence of a sentinel pile adversely affects the outcome of treatment of chronic anal fissures with glyceryl trinitrate ointment, and a long history of the fissure reduces the rate of initial healing. Reasons for these findings are discussed. |
| | |
Authors:
|
J Pitt; S Williams; P M Dawson |
Related Documents
:
|
18172679 - Impact of stapled haemorrhoidopexy on stool continence and anorectal function: long-ter... 17466039 - Does fecal diversion offer any chance for spontaneous closure of the radiation-induced ... 11574089 - Preservation of the inferior mesenteric artery in colorectal resection for complicated ... 12699099 - Stapled haemorrhoidectomy compared with milligan-morgan excision for the treatment of p... 10562579 - Rectal epithelial apoptosis in familial adenomatous polyposis patients treated with sul... 2737059 - Anal manometry improves the outcome of surgery for fistula-in-ano. 7048179 - Total keratoplasty in peripheral corneal degeneration. 2092029 - Double-blind comparison of the safety and efficacy of famotidine with ranitidine in pat... 19061519 - Transurethral resection of the prostate in northern nigeria, problems and prospects. |
Publication Detail:
|
Type: Journal Article |
Journal Detail:
|
Title: Diseases of the colon and rectum Volume: 44 ISSN: 0012-3706 ISO Abbreviation: Dis. Colon Rectum Publication Date: 2001 Jun |
Date Detail:
|
Created Date: 2001-06-06 Completed Date: 2001-07-12 Revised Date: 2004-11-17 |
Medline Journal Info:
|
Nlm Unique ID: 0372764 Medline TA: Dis Colon Rectum Country: United States |
Other Details:
|
Languages: eng Pagination: 864-7 Citation Subset: IM |
Affiliation:
|
Colorectal Surgical Unit, West Middlesex University Hospital NHS Trust, Isleworth, Middlesex, United Kingdom. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Administration, Topical Adult Chronic Disease Female Fissure in Ano / drug therapy* Humans Male Middle Aged Nitroglycerin / administration & dosage*, pharmacology Recurrence Risk Factors Treatment Outcome Vasodilator Agents / administration & dosage*, pharmacology Wound Healing |
| Chemical | |
Reg. No./Substance:
|
0/Vasodilator Agents; 55-63-0/Nitroglycerin |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Total pelvic mesh repair: a ten-year experience.
Next Document: Staged excision and split-thickness skin graft for circumferential perianal Paget's disease.