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1.
Anal fissure is one of the most common and painful proctological pathologies affecting mainly young individuals. The physiopathology in the development of a chronic anal fissure seems to be a combination of internal anal sphincter hypertonia and poor vascularization at the posterior midline. Treatment of acute fissures is conservative with supportive therapy, leading to healing in the majority of the patients. Open or closed lateral internal sphincterotomy is the treatment of choice for chronic anal fissures. In low pressure chronic fissures, sphincterotomy should be avoided and a V-Y island advancement flap may be an alternative procedure. Sphincterotomy can induce anal incontinence, a feared complication of this technique. Recent interest has developed in chemical sphincterotomy with local botulin toxin injections or glyceryl trinitrate application. Long-term follow-up is needed to evaluate these new therapeutic options. 相似文献
2.
Elsebae MM 《World journal of surgery》2007,31(10):2052-2057
Background Troublesome fecal incontinence following a lateral internal sphincterotomy is often attributed to faulty surgical technique.
However, it may be associated with coexisting occult sphincter defects. Whether continence is related to the extent of sphincterotomy
remains debatable. The aim of the study is to identify fecal incontinence related to chronic anal fissure before and after
lateral internal sphincterotomy and its relationship to the extent of internal anal sphincter division.
Methods One hundred eight patients with chronic anal fissure were prospectively studied before and after lateral internal sphincterotomy.
A questionnaire was completed for each patient before and after surgery with regard to any degree of fecal incontinence. Fecal
incontinence severity index was assessed using the Cleveland Clinic Incontinence Score. The patients with preoperative perfect
continence were randomized into two groups (46 patients in each group): Group 1 underwent traditional lateral internal sphincterotomy
(up to the dentate line) and Group 2 were underwent a conservative internal anal sphincterotomy (up to the height of the fissure
apex or just below it).
Results Minor degrees of incontinence were present before surgery in 16 patients (14.8%). Results of the randomized trial revealed
that temporary postoperative incontinence was newly developed in 6/92 of patients (6.52 %) who did not have it before surgery.
Five of the six (10.86%) were in Group 1 one (2.17%) was in Group 2 (p = 0.039). Persistent incontinence occurred in two in Group 1 (4.35%). All of them were females. All have had a history of
one or more vaginal deliveries.
Conclusion A mild degree of fecal incontinence may be associated with chronic anal fissure at presentation rather than as a result of
internal sphincterotomy. Troublesome fecal incontinence after lateral internal sphincterotomy is uncommon. Sphincterotomy
up to the dentate line provided faster pain relief and faster anal fissure healing, but it was associated with a significant
postoperative alteration in fecal incontinence than was sphincterotomy up to the fissure apex. Care should be exercised in
female patients with a history of previous obstetric trauma, as internal anal sphincter division may further compromise sphincter
function. 相似文献
3.
A. Cariati 《Acta chirurgica Belgica》2013,113(5):322-324
Introduction : Anal fissure is a common disease. Usually chronic anal fissures are managed medically. When conservative management fails, surgical treatment should be considered. Lateral internal sphincterotomy has been advocated as the first choice invasive treatment but it has a reported rate of major fecal incontinence of 5%. In order to reduce the onset of major fecal incontinence after anal fissure surgery, it has been proposed to use the anal stretching plus fissurectomy.Methods : From 2008 to 2011, 457 patients have been operated for chronic anal fissure.Results : Twenty-seven patients underwent lateral internal sphincterotomy, two patients underwent posterior sphincterotomy and 428 patients underwent anal stretch plus fissurectomy. Satisfactory results have been reported in 95% of the cases. Transient incontinence rates have been of 3% after anal stretch and of 14,8% after lateral internal sphincterotomy (p < 0,05). Major and persistent incontinence rates have been reported in a case after later internal sphincterotomy (3%) but never after anal stretching (p = 0,059). Recurrence occurred in 2% of the patients after anal stretch and in 3% of the cases after lateral internal sphincterotomy (p = ns).Conclusion : Lateral internal sphincterotomy and anal stretch have nearly a reported 95% of good results but the first have 3–5% rates of major incontinence. 相似文献
4.
Arroyo A Pérez F Serrano P Candela F Lacueva J Calpena R 《American journal of surgery》2005,189(4):429-434
BACKGROUND: The aim of this prospective randomized trial was to compare the effectiveness and morbidity of surgical versus chemical sphincterotomy in the treatment of chronic anal fissure after a 3-year follow-up. METHODS: Eighty patients with chronic anal fissure were treated by whether open lateral internal sphincterotomy (group 1) or chemical sphincterotomy with 25 U botulinum toxin injected into the internal sphincter (group 2). Clinical and manometric results were analyzed. RESULTS: Overall healing was 92.5% in the open sphincterotomy group and 45% in the toxin botulinum group (P<.001). There is a group of patients with clinical (duration of disease >12 months and presence of a sentinel pile before treatment) and manometric factors (persistently elevated mean resting pressure, % of time presence of slow waves, and number of patients or the time presence ultra slow waves after treatment) associated with a higher recurrence of anal fissure. The final percentage of incontinence was 5% in the open sphincterotomy group and 0% in the botulinum toxin group (P>.05). CONCLUSION: We recommend surgical sphincterotomy as the first therapeutic approach in patients with clinical and manometric factors of recurrence. We prefer the use of botulinum toxin in patients older than 50 years or with risk factors for incontinence, despite the higher rate of recurrence, since it avoids the greater risk of incontinence in the surgical group. 相似文献
5.
Lateral internal sphincterotomy is the surgical treatment of choice of chronic anal fissure after failure of conservative measures. Several randomized trials identified an overall risk of incontinence of 10 % mostly for flatus. Fissurectomy is the most commonly used procedure to preserve the integrity of the anal sphincters. However, a possible complication is keyhole defect that may lead to faecal soiling. In this study, chronic anal fissure (CAF) was treated by fissurectomy and anal advancement flap to preserve the anatomo-functional integrity of sphincters and to reduce healing time and the risk of anal stenosis. In patients with hypertonia, surgical treatment was combined with chemical sphincterotomy by injection of botulinum toxin to enhance tissue perfusion. Forty eight patients with CAF underwent fissurectomy and anal advancement flap. In 22 subjects with hypertonia of the internal anal sphincter, intrasphincter injection of 30 UI of botulinum toxin at the completion of the surgical operation was used. All patients were followed up to 24 months. Since the first defecation, the intensity and duration of pain were significantly reduced. Two patients had urinary retention, five had infections and three had partial breakdowns. No anal stenosis, keyhole deformity or necrosis flap was recorded. At the 24 months follow-up visit, anal incontinence was similar to those detected preoperatively. Only four recurrences were detected at 18 and 20 months. After medical treatment failure, fissurectomy with advancement flap is a valid sphincter-conserving procedure for treatment of anterior or posterior CAF, regardless of hypertonia of the internal anal sphincter. 相似文献
6.
Arroyo A Pérez-Vicente F Serrano P Candela F Sánchez A Pérez-Vázquez MT Calpena R 《Cirugía espa?ola》2005,78(2):68-74
Chronic anal fissure is a common benign anorectal problem in Western countries that substantially impairs the patient's life. Consequently, a rapid and effective solution is required. We reviewed the various treatments for chronic anal fissure described in the literature, with the aim of establishing a therapeutic protocol. We recommend surgical sphincterotomy (preferably open or closed lateral sphincterotomy) as the first therapeutic approach in patients with chronic anal fissure. However, we prefer the use of chemical sphincterotomy (preferably botulinum toxin) in patients aged more than 50 years old and in those with previous incontinence, risk factors for incontinence (previous anal surgery, multiple vaginal births, diabetes, inflammatory bowel disease, etc.), or without anal hypertonia, despite the higher recurrence rate with medical treatments, since this procedure avoids the greater risk of residual incontinence described in the literature with surgical sphincterotomy in this group of patients. 相似文献
7.
Neda Valizadeh Niloufar Yahyapour Jalaly Mohsen Hassanzadeh Fereshteh Kamani Zohreh Dadvar Shapour Azizi Babak Salehimarzijarani 《Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie》2012,397(7):1093-1098
Purpose
Lateral internal sphincterotomy has been the gold standard treatment for chronic anal fissure, but it still carries the risk of permanent damage of the anal sphincter, which has led to the implementation of alternative treatment like botulinum toxin injection. The aim of this randomized prospective controlled trial was to compare the efficacy and morbidity of botulinum toxin injection and lateral internal sphincterotomy in the treatment of chronic anal fissure.Methods
Fifty consecutive adults with chronic anal fissure were randomly treated with either lateral internal sphincterotomy or botulinum toxin (BT) injection with 50 U BT into the internal sphincter. The complications, healing and recurrence rate, and incontinence score were assessed 2, 3, 6, 12 months after the procedure.Results
Inspection at the 2-month visit revealed complete healing of the fissure in 11 (44?%) of the patients in the BT group and 22 (88?%) of the patients in the lateral internal sphincterotomy (LIS) group (p?=?0.001). At the 3-month visit, there was no significant difference between the two groups in healing. The overall recurrence rate after 6 months in the BT group was higher than in the LIS group (p?<?0.05). In the 3-month follow-up, the LIS group had a higher rate of anal incontinence compared to the BT group (p?<?0.05). The final percentage of incontinence was 4?% in the LIS group (p?>?0.05).Conclusions
The treatment of chronic anal fissure must be individualized depending on the different clinical profiles of patients. Botulinum toxin injection has a higher recurrence rate than LIS, and LIS provides rapid and permanent recovery. However, LIS carries a higher risk of anal incontinence in patients. 相似文献8.
R. Farouk J. Gunn G. S. Duthie 《Annals of the Royal College of Surgeons of England》1998,80(3):194-196
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. 相似文献
9.
为探讨控制性括约肌侧切术治疗陈旧性肛裂的疗效,将118例陈旧性肛裂患者随机分为两组,分别采用控制性内括约肌侧切术(治疗组)和传统的内括约肌侧切扩肛术(对照组)治疗,并对比分析两组治疗结果。结果显示,两组患者均一次性治愈,均无大便失禁发生。但治疗组和对照组分别有1例和6例肛门气体失禁。随访至今,治疗组无复发,对照组复发1例。结果表明,控制性括约肌侧切术减少了不必要的组织损伤,更好地保护了肛门功能,可~次性治愈陈旧性肛裂,且操作简单,适合基层医疗单位推广应用。 相似文献
10.
Osman Yüksel Hasan Bostanci Sezai Leventoğlu T. Tolga Şahin B. Bülent Menteş 《Journal of gastrointestinal surgery》2008,12(6):1110-1114
Objective Keyhole deformity is frequently encountered after posterior internal sphincterotomy but may be observed after lateral internal
sphincterotomy or in patients without any history of previous anal surgery. The aim of the present study is to emphasize the
surgical significance of this entity and discuss the possible strategies in the treatment of the deformity.
Material and Methods Patients in whom keyhole deformity developed after surgical or conservative treatment applied for chronic anal fissure in
our clinic and patients referred from other centers were recruited.
Results Nine-hundred twenty-six patients were treated for chronic anal fissure. A hundred of these patients directly underwent lateral
internal sphincterotomy. The remaining 826 patients initially received conservative management, and 676 of them eventually
underwent lateral internal sphincterotomy. In total, 15 patients were diagnosed to have significant keyhole deformity. Initially,
all patients received conservative treatment for keyhole deformity, which was successful in two patients. Of the 13 patients
in whom conservative management failed, nine underwent advancement flap reconstruction and the remaining four diamond flap
reconstruction.
Conclusion Keyhole deformity is occasionally seen as a late complication of chronic anal fissure and may be well tolerated by the patients
without any well-defined symptoms. The treatment strategy is directed toward the degree of functional alteration.
This study was presented at the 11th Meeting of the Turkish Society of Colon and Rectal Surgery, Bodrum, August 26–30 2007. 相似文献
11.
50 patients have been followed up after lateral internal sphincterotomy for chronic anal fissure. The results are excellent. This operation has some advantages over against the posterior sphincterotomy or the sphincter stretching and should replace these latter procedures in the treatment of chronic anal fissure. The lateral internal sphincterotomy may probably be applied for other benign anal lesions. 相似文献
12.
Introduction Lateral sphincterotomy is now the standard surgical treatment for fissure‐in‐ano. Healing is achieved in 90% of cases, however, sphincterotomy also carries a significant risk of incontinence. Traditional sphincterotomy comprises of division of the internal sphincter up to the level of the dentate line, a more conservative division could lead to a lower incontinence rate, with an equivalent healing rate. Materials and methods A total of 65 patients undergoing conservative lateral sphincterotomy under a single operator between January 1996 and January 2002 were reviewed. Specific questions were asked regarding overall success of the operation, leakage of fluid, faeces or flatus and recurrence of fissure symptoms. Supplemental data was obtained from a retrospective analysis of the patients' case notes to ascertain demographics, length of hospital stay and complication rate. Results Sixty of 65 patients responded to our postal questionnaire. The male to female ratio was 1 : 1 and the mean age 40.3 years of age. No complications were recorded and 97% of patients had achieved fissure healing by the time of their out‐patient follow‐up (mean 6.9 weeks). Two patients reported new incontinence following their procedure; one patient experienced incontinence of fluid and flatus (1.7%) and the remaining patient complained of incontinence to flatus only. No patients experienced incontinence of faeces. Eleven patients experienced persistent symptoms of pain and bleeding but only 6 of these patients required treatment from their general practitioner which consisted of stool softeners and topical analgesia. No patients required re‐operation. Conclusion A conservative division of the internal anal sphincter results in adequate fissure healing and a much lower incontinence rate than that previously recorded in the literature for more traditional divisions of the internal anal sphincter. 相似文献
13.
Background We compare lateral internal sphincterotomy as an effective treatment of chronic fissure in ano to fissurectomy, which is as
an alternative surgical treatment.
Methods Sixty two consecutive patients were divided into two groups through sequential sampling. Thirty patients underwent fissurectomy
and 32 underwent lateral internal sphincterotomy. After a median follow-up of 22 months, we compared the results of the two
procedures. In addition to frequent visits on a predetermined basis, a telephone inquiry into fissure recurrence and continence
status was made.
Results All patients in both groups were pain-free and without bleeding within 1 week. In both groups, urinary retention was noted
in one patient. Incontinence to flatus was noted in the fissurectomy (F) group in two (6.2%) patients, but no incontinence
was noted in the lateral internal sphincterotomy (LIS) group. There was one patient (3.1%) with fissure recurrence in the
F group but none in the LIS group. No patient in either group was afflicted with anal stenosis or perianal infections. All
wounds healed within 8 weeks. Twenty nine patients (96.6%) in the LIS group and 28 (87.5%) in the F group reported satisfactory
results with their procedure.
Conclusion In the surgical treatment of chronic anal fissure not responding to conservative management, LIS may be the better treatment
and, perhaps, the preferable surgical technique with fewer total complications (P < 0.005). 相似文献
14.
When the conservative treatment of the chronic anal fissure (nitrates, topical calcium channel blockers, topical nifedipine, lignocaine and cortisone compounds) proves to be inefficient, the surgery may be opted for. From among all surgical procedures (anal dilation, fissure excision, anal advancement flap) we have opted for closed internal and lateral sphincterotomy. During the period of 1990-2002, there have been performed by just one surgeon 47 sphincterotomies (15 men-32 women), average age 49 (23-76). Results: There has not been any case of anal incontinence for gases or faeces, precocious or late; 1 para anal hematoma (2.12%) solved through puncture; 2 anal abscesses (4.25%), solved through incision and tegmen drainage. Control in 6 month's time and 1 year time: normal quality of life, without any subjective complaints; painless rectal touch, healing of the fissure, extensible anal sphincter, normal continence. The sphincterotomy was followed by the disappearance of the cleft syndrome with all patients. Although the literature contains citations of transitory and minimum incontinence in 2-4% of the cases, we have not noticed in any; no recurrences have been registered; morbidity is acceptable. The future will decide if, between sphincterotomy and the injection with the botulinum toxin, the latter one is to be preferred. 相似文献
15.
Kanellos I Angelopoulos S Zacharakis E Kanellos D Pramateftakis MG Blouhos K Betsis D 《European surgical research. Europ?ische chirurgische Forschung. Recherches chirurgicales européennes》2005,37(5):317-320
The aim of this prospective study is to describe the combined technique and results of stapled haemorrhoidopexy and lateral internal sphincterotomy for patients suffering from prolapsing 3rd-degree haemorrhoids and chronic fissure-in-ano. During the period from 1999 to 2004, 26 patients underwent combined surgical treatment for anal fissure and prolapsing symptomatic haemorrhoids. Preoperative and postoperative clinical evaluation and the patient's degree of satisfaction were recorded. Early complications included faecal urgency (3 patients) and pain (2 patients). Complete continence was restored within 10 weeks in all patients except 1 who had persisting incontinence to flatus. All fissures healed completely within 4 weeks. No haemorrhoidal or fissure recurrence has been observed during follow-up. The combination of stapled haemorrhoidopexy and lateral internal sphincterotomy is a safe and effective procedure for the treatment of prolapsing 3rd-degree haemorrhoids and chronic anal fissures. 相似文献
16.
Comparative Study of Glyceryl Trinitrate Ointment Versus Surgical Management of Chronic Anal Fissure
Tauro LF Shindhe VV Aithala PS Martis JJ Shenoy HD 《The Indian journal of surgery》2011,73(4):268-277
Chronic Anal Fissure (CAF) is common perineal condition and well-known painful entity. Standard surgical treatment even though
available, may require long hospital stay and sometimes have worrying complications like anal incontinence. So non-surgical
treatment, Glyceryl Trinitrate has been shown to be an effective for chronic anal fissure. It decreases anal tone and ultimately
heals the anal fissure. The present study is the attempt to know the efficacy of 0.2% Glyceryl Trinitrate ointment in the
treatment of chronic anal fissure and to compare the effectiveness of 0.2% Glyceryl Trinitrate ointment (GTN) versus fissurectomy
with lateral internal sphincterotomy (LIS) and fissurectomy with posterior internal sphincterotomy (PIS) in the management
of chronic anal fissure. This is a prospective comparative study of management of chronic anal fissure done in our hospital
during the period of one and half year from October 2005 to March 2007. Thirty patients treated with 0.2% Glyceryl Trinitrate
ointment and 30 patients treated with fissurectomy and lateral internal sphincterotomy and 30 patients treated with posterior
internal sphincterotomy, for chronic anal fissure were selected for study. A single brand of 0.2% Glyceryl Trinitrate ointment
(Nitrogesic) used for trial arm. Dose of administration was 1.5 cm to 2 cm in the anal canal with device provided by manufacturers
of the proprietary preparation and applied twice a daily for 12 weeks. Patients were followed up for 12 weeks and thereafter
evaluated for relief of symptoms in all three groups. Observations were recorded at 2 weeks; 6 weeks and 12 weeks of follow
up period, regarding symptoms like pain and bleeding during defecation, healing of CAF and also for side effects like headache
in GTN group and flatus, fecal incontinence in surgical groups. Data collected in proforma and analyzed. Study revealed CAF
was more in male 59 patients (66%) than the female 31 patients (34%), the ratio being 1: 0.52. The maximum number of patients
was encountered in the age group of 20 to 40 years with mean duration of age 34.14 years. In all three groups symptoms like
pain, bleeding, constipation and sphincter spasm were present. Sentinel pile was present in 56% of the patients. Common site
of fissure was found to be posterior in 94% of patients. Observations with respect to relief of pain, no bleeding and healing
were recorded at 2, 6 and 12 weeks of duration. Lateral sphincterotomy remains effective but should be reserved for the patients
who fail to respond to initial chemical sphincterotomy or GTN therapy. GTN is good alternative mode of therapy for patients
who refuse surgery and prefer medical line of treatment. 相似文献
17.
Fissurectomy and isosorbide dinitrate for chronic fissure in ano not responding to conservative treatment 总被引:6,自引:0,他引:6
BACKGROUND: Although lateral sphincterotomy heals chronic fissure in ano in over 90 per cent of cases it is a surgical technique with inherent complications. To avoid such complications, chronic fissure in ano was treated by fissurectomy in this study. To enhance postoperative tissue perfusion allowing stable wound healing, fissurectomy was combined with temporary chemical sphincterotomy by a nitric oxide donor cream. METHODS: Seventeen consecutive patients (ten women) with chronic fissure in ano not responding to conservative management underwent diathermy fissurectomy. After operation patients used a 1 per cent isosorbide dinitrate cream. Postoperative follow-up continued until wounds had healed, at which time anal endosonography was performed. A telephone inquiry into fissure recurrence and continence status was made. RESULTS: Seventeen patients underwent fissurectomy, without postoperative complications. All wounds had healed within 10 weeks. No fissure recurrence was seen after a median follow-up of 29 months. Histopathology showed non-specific scar tissue without signs of internal anal sphincter fibrosis. Postoperative endosonography showed no evidence of new internal sphincter defects. CONCLUSION: In the treatment of chronic anal fissure not responding to chemical sphincterotomy with nitric oxide donors, fissurectomy in combination with isosorbide dinitrate cream may be a sphincter-sparing surgical technique. 相似文献
18.
This is a retrospective analysis of the results obtained with surgical treatment consisting in left lateral partial subcutaneous sphincterotomy for anal fissure. Fifty patients observed from January 2002 to June 2005 in our Coloproctology outpatients' department were recruited. Five patients (10%) did not undergo an operation and all 5 presented an acute anal fissure. Their treatment was conservative consisting in fibre ingestion, use of stool softeners, ointments, anti-inflammatory agents after opening the bowel, and a corticosteroid ointment. Forty-five patients (90%) were operated on. Twelve of these (26%) were operated on for an acute anal fissure after early failure of conservative therapy and demanded immediate surgical therapy; 14 (31%) of those operated on for acute anal fissure underwent a surgical procedure after at least a month of conservative treatment. The remaining 19 patients (42%) presented chronic anal fissures, with symptoms lasting more than 1 month and with sentinel haemorrhage, a hypertrophied anal papilla, and hardening of the edge of the fissures. Forty of the patients operated on (88%) presented a posterior anal fissure, 3 patients (6.5%) an anterior anal fissure and 2 patients (4.5%) synchronous anterior and posterior anal fissures. The surgical procedure carried out on all patients undergoing operation was a partial left lateral subcutaneous internal sphincterotomy using the closed technique according to Notoras under general anaesthesia. Follow-up was carried out 15 days and 2, 3 and 6 months postoperatively. The results were considered very good in 89% of the cases, while 5 patients (11%) complained of pain after opening the bowels, albeit of acceptable intensity and such as not to require another operation or significant pharmacological treatment. No complications were observed. The conclusion after the analysis of our experience is in agreement with the 8th recommendation, class I, recommendation grade A of the "The Standards Practice Task Force of the American Society of Colon and Rectal Surgeons" stating that "surgery may be appropriately offered without a trial of pharmacologic treatment after failure of conservative therapy" and that "in our experience can be proposed in those cases of acute anal fissure". In our experience, the 89% success rate and substantial patient satisfaction make this procedure more appropriate than medical treatment and alternative surgical treatments. 相似文献
19.
Philippe Tranqui Daniel C Trottier Charles Victor Joel B Freeman 《Canadian journal of surgery》2006,49(1):41-45
BACKGROUND: Surgical sphincterotomy for chronic anal fissure can cause fecal incontinence. This has led to the investigation of nonsurgical treatment options that avoid permanent damage to the internal anal sphincter. METHODS: We conducted a retrospective, ongoing chart review with telephone follow-up of 88 patients treated for chronic anal fissure between November 1996 and December 2002. During the first half of the study period, patients were treated with topical nitroglycerin and pneumatic dilatation. With the availability of new therapies in June 1999, subsequent patients received topical nifedipine and botulinum toxin injections (30-100 units). Lateral anal sphincterotomy was reserved for patients who failed medical treatment. RESULTS: In 98% of patients the fissure healed with conservative nonsurgical treatment. The combination of nifedipine and botulinum toxin was superior to nitroglycerin and pneumatic dilatation with respect to both healing (94% v. 71%, p < 0.05) and recurrence rate (2% v. 27%, p < 0.01). There was no statistical difference between the number of dilatations and botulinum toxin injections needed to achieve healing. Three patients who received botulinum toxin reported mild transient flatus incontinence. At an average telephone follow-up of 27 months, 92% of patients reported having no pain or only mild occasional pain with bowel movements. CONCLUSIONS: Chronic anal fissures can be simply and effectively treated medically without the risk of incontinence associated with sphincterotomy. Topical nifedipine and botulinum toxin injections are an excellent combination, associated with a low recurrence rate and minimal side effects. 相似文献
20.