Presentaciones de la sífilis anorrectal: la gran simuladora / Anorectal syphilis presentations: the great pretender

Antecedentes: La sífilis es una infección sexualmente transmisible sistémica crónica que afecta a docenas de millones de personas al año. A nivel anorrectal, su manifestación polimórfica obliga al diagnóstico diferencial con enfermedades anorrectales benignas y malignas. Objetivo: Describir las diferentes presentaciones de la sífilis anorrectal a propósito de 5 casos clínicos. Método: Estudio observacional, retrospectivo, descriptivo. Resultados: La mayoría de los pacientes fueron VIH positivos en edad sexual activa. Las manifestaciones registradas, al igual que las reportadas en la bibliografía fueron las fisuras, úlceras perianales y pseudotumores. Conclusiones: La sífilis es considerada "la gran simuladora". En la localización anorrectal se requiere una alta sospecha diagnóstica para diferenciarla de presentaciones similares de otras enfermedades anales benignas, la enfermedad inflamatoria intestinal y el cáncer anorrectal, con el fin de evitar el consiguiente riesgo de sobretratamiento. (AU)

Background: Syphilis is a chronic systemic sexually transmitted infection that affects tens of millions of people annually. At the anorectal level, its polymorphic manifestation requires differential diagnosis with benign and malignant anorectal diseases. Objective: To review the presentation of anorectal syphilis from 5 clinical cases. Methods: Observational, retrospective, descriptive study. Results: Most of the patients were HIV positive in sexually active age. The manifestations recorded and reported in the literature were fissures, perianal ulcers, and pseudotumors. Conclusions: Syphilis is considered "the great pretender". In anorectal syphilis, a high diagnostic suspicion is needed to differentiate it from similar presentations due to other anal conditions, inflammatory bowel disease, and anorectal cancer, to avoid the consequent risk of overtreatment. (AU)

Efectividad del tratamiento con plasma rico en plaquetas y leucocitos en la fisura anal secundaria / Effectiveness of Treating Secondary Anal Fissure with Platelet and Leukocyte-Rich Plasma

Introducción: El plasma rico en plaquetas es un producto derivado de la sangre, rico en péptidos y proteínas de señalización intercelular, así como citoquinas capaces de intervenir en cada una de las etapas de la regeneración de varios tejidos. Objetivo: Evaluar la efectividad del tratamiento con plasma rico en plaquetas y leucocitos en pacientes con fisura anal secundaria que asistieron a la consulta de Coloproctología del Hospital Docente Provincial Oncológico María Curie de Camagüey en el período de enero de 2020 a enero de 2023. Métodos: Se realizó un estudio cuasiexperimental. El universo lo conformaron todos los pacientes que acudieron a consulta en ese período. La muestra no probabilística intencionada la conformaron 130 pacientes adultos con diagnóstico de fisura anal secundaria que recibieron tratamiento con plasma rico en plaquetas y leucocitos. Resultados: El tiempo de cicatrización de la fisura anal permitió corroborar la efectividad del tratamiento; además, la mayoría de los pacientes evolucionaron de forma favorable. El dolor fue la complicación más visible pues presentó significación estadística al establecer la relación entre las variables. Se demostró que el tratamiento con plasma rico en plaqueta y leucocitos en pacientes con fisura anal secundaria es efectivo y seguro en la evaluación final del tratamiento. Conclusiones: Lo expuesto permite considerar que los pacientes tratados obtuvieron buenos resultados al hacer uso del plasma rico en plaquetas y leucocitos. Por consiguiente, tiene un resultado positivo en no mostrar complicaciones y una alta posibilidad de que el paciente tratado evolucione en mejor condición(AU)

Introduction: Platelet-rich plasma is a blood-derived product, rich in peptides and intercellular signaling proteins, as well as cytokines capable of intervening in each of the stages of regeneration of various tissues. Objective: To assess the effectiveness of treatment with platelet- and leucocyte-rich plasma in patients with secondary anal fissure who attended the coloproctology office at Hospital Docente Provincial Oncológico María Curie of Camagüey from January 2020 to January 2023. Methods: A quasiexperimental study was carried out, whose universe consisted of all the patients who came for consultation during that period. The nonprobabilistic purposive sample consisted of 130 adult patients with a diagnosis of secondary anal fissure who received treatment with platelet- and leucocyte-rich plasma. Results: The healing time of the anal fissure allowed corroborating the effectiveness of the treatment; in addition, most of the patients evolved favorably. Pain was the most visible complication since it presented statistical significance when the relationship between the variables were established. Treatment with platelet- and leucocyte-rich plasma in patients with secondary anal fissure proved effective and safe in the final assessment of the treatment. Conclusions: The above allows considering that the treated patients obtained good outcomes when making use of platelet- and leucocyte-rich plasma. Therefore, it has a positive outcome, not showing complications and a high possibility for the treated patient to evolve in a better condition(AU)

Caracterización del tratamiento con plasma rico en plaquetas y leucocitos en la fisura anal secundaria / Characterization of the Treatment with Platelet-Rich Plasma and Leukocytes against Secondary Anal Fissure

Introducción: Las enfermedades benignas de recto son muy frecuentes en la práctica médica habitual en todos los niveles de atención de salud. Dentro de estos procesos se reconoce que la fisura anal es uno de los más comunes. Objetivo: Caracterizar a los pacientes tratados con plasma rico en plaquetas y leucocitos por fisura anal secundaria en la provincia Camagüey en el período comprendido entre septiembre del 2020 y septiembre del 2022. Métodos: Se realizó un estudio cuasiexperimental, cuyo universo lo conformaron los pacientes con el diagnóstico de fisura anal secundaria que asistieron a la consulta de Coloproctología del Hospital Provincial Docente Oncológico María Curie. Se estableció una muestra no probabilística a criterio de los autores conformada por 132 pacientes adultos, quienes recibieron tratamiento con plasma rico en plaquetas y leucocitos por fisura anal secundaria en la provincia Camagüey. Resultados: Con respecto al sexo y a la edad, se observó una mayor frecuencia del grupo de 40 a 49 años y predominó el sexo femenino. El síntoma de mayor frecuencia fue el dolor, mientras que en la etiología prevaleció la proctitis facticia. En la mayoría de los casos estudiados la fisura anal cicatrizó en menos de 15 días y en cuanto a la evaluación final del tratamiento solo la minoría empeoró. Conclusiones: La caracterización de la muestra en estudio permite afirmar que el tratamiento con plasma rico en plaquetas y leucocitos tiene beneficios para los pacientes con fistulas perianales y su calidad de vida(AU)

Introduction: Benign rectal diseases are very frequent in routine medical practice at all levels of health care. Among these processes, anal fissure is recognized as one of the most common. Objective: To characterize patients treated with platelet-rich plasma and leukocytes for secondary anal fissure in Camagüey Province between September 2020 and September 2022. Methods: A quasiexperimental study was carried out, whose universe was made up of patients with the diagnosis of secondary anal fissure who attended the coloproctology office at Hospital Provincial Docente Oncológico María Curie. A nonprobabilistic sample was established according to the authors' criterions, made up of 132 adult patients who received treatment with platelet-rich plasma and leukocytes for secondary anal fissure in Camagüey Province. Results: Regarding sex and age, a higher frequency was observed in the group 40 to 49 years old and the female sex was predominant. The most frequent symptom was pain, while the prevailing etiology was factitious proctitis. In most of the cases under study, the anal fissure healed in less than 15 days and, regarding the final assessment of the treatment, only the minority worsened. Conclusions: The characterization of the sample under study allows to affirm that treatment with platelet-rich plasma and leukocytes has benefits for patients with perianal fistulas and their quality of life(AU)

Lisado plaquetario en el tratamiento de la fisura anal crónica y otras indicaciones

Introducción: La aplicación del lisado plaquetario alogénico en el tratamiento de la fisura anal crónica es uno de los temas más novedosos y excitantes dentro de las ciencias biomédicas hoy día. Objetivo: Exponer en forma resumida los avances y perspectivas de empleo del lisado plaquetario alogénico en la fisura anal. Métodos: La estrategia de búsqueda abarcó información en diferentes bases de datos como internet y en el buscador google académico, se utilizaron 42 bibliografías seleccionadas para realizar la revisión, 35 publicadas en los últimos cinco años como artículos originales de revisión, monografías y otros documentos científicos especializados en el tema. A partir de la búsqueda se elaboró el presente artículo. Desarrollo: Se hace alusión a la conceptualización de la enfermedad y los pilares terapéuticos, se sustenta la utilización del lisado plaquetario alogénico; los logros alcanzados con su aplicación en el Hospital General Docente "Comandante Pinaresˮ del municipio San Cristóbal en la provincia Artemisa en la especialidad; así como a las potencialidades de tan promisorio campo en el presente siglo. Conclusiones: El Lisado plaquetario alogénico en el tratamiento de la fisura anal crónica constituyó una nueva modalidad de tratamiento de la enfermedad.

Introduction: The application of allogeneic platelet lysate in the treatment of chronic anal fissure is one of the most novel and exciting topics within biomedical sciences today. Objective: To summarize the advances and perspectives of the use of allogeneic platelet lysate in anal fissure. Methods: The search strategy included information in different databases such as the internet and the academic google search engine, 42 bibliographies selected for the review were used, 35 published in the last five years as original review articles, monographs and other scientific documents specialized in the subject. The present article was prepared on the basis of the search. Development: Allusion is made to the conceptualization of the disease and the therapeutic pillars, the use of allogeneic platelet lysate is sustained; the achievements reached with its application in the General Teaching Hospital "Comandante Pinaresˮ of San Cristóbal municipality in Artemisa province in the specialty; as well as to the potential of such promising field in the present century. Conclusions: Allogeneic platelet lysate in the treatment of chronic anal fissure constituted a new modality of treatment of the disease.

Clinical trial combining botulinum toxin A injection and fissurectomy for chronic anal fissure: a dose-dependent study

ABSTRACT Background Anal fissure is a common surgical disease that is usually treated conservatively. The golden surgical treatment for anal fissure is lateral internal sphincterotomy, but it may result in multiple complications. Therefore, other treatment methods have recently been introduced, and one of them is the injection of botulinum toxin A (BTA) and fissurectomy. In the present study, we aim to evaluate the effectiveness of the combination of fissurectomy and BTA injection in the treatment of chronic anal fissure by single surgeon. Materials and Methods The present is a non-randomized prospective cohort study conducted by a single surgeon in Saudi Arabia. Our sample was composed of 116 female patients, with mean age of 36.57 ± 11.52 years, who presented to our Surgical Outpatient Clinic with chronic anal fissure between October 2015 and July 2020, and were treated with BTA injection combined with fissurectomy. They were followed up for 1, 2, 3, 4, and 8 weeks, and after one year to evaluate the efficacy and safety of the treatment. The main outcomes analyzed were symptomatic relief, complications, recurrence, and the need for further surgical intervention. Results The treatment with BTA injection combined with fissurectomy was effective and safe in 115 patients (99.1%) at 1 year of follow-up. A total of 5 patients experienced recurrence at 8 weeks, which resolved completely with pharmacological sphincterotomy, and 12 patients experienced minor incontinence, which disappeared later. Conclusion In total, 70 units of BTA injection combined with fissurectomy is a suitable second-line treatment of choice for chronic anal fissure, with a high degree of success and a low rate of major morbidity. (AU)

Esfinterotomía lateral interna vs. toxina botulínica como tratamiento de la fisura anal / Lateral Internal Sphincterotomy versus Botulinum Toxin as Treatment of Anal Fissure

Introducción: La fisura anal crónica es una entidad frecuente que produce molestias durante y después de la defecación, su fisiopatología no es clara y su manejo es variado. La esfinterotomia lateral interna es una de las técnicas más utilizadas, aunque su elevado porcentaje de incontinencia no es aceptado y la inyección de toxina botulínica es una alternativa tentadora. Objetivo: Comparar los resultados de la inyección de toxina botulínica tipo A con la esfinterotomia lateral interna para tratamiento de la fisura anal en cuanto a dolor postoperatorio, recurrencia, curabilidad e incontinencia. Métodos: Se realizó un estudio tipo cohorte. A un grupo de 40 pacientes se trató con inyección de 50 UI de Toxina Botulínica tipo A y el otro grupo de 42 pacientes se le realizó esfinterotomia lateral interna. Los resultados se comparan estadísticamente para CI95 y error de 0,05. Resultados: La esfinterotomia vs toxina botulínica, resultó en cuanto a curabilidad en un 85,4 por ciento de los casos contra un 77,5 por ciento. Las recidivas se presentaron en 4,8 por ciento / 12,5 por ciento, la incontinencia ocurrió en 9,5 por ciento / 2,5 por ciento y el dolor posoperatorio estuvo presente en el 14,8 por ciento / 5,0 por ciento. Conclusiones: La esfinterotomia resultó mejor en cuanto a curabilidad y recidivas, mientras la aplicación de la toxina botulínica presentó mejores resultados en la incontinencia fecal y el dolor posoperatorio(AU)

Introduction: Chronic anal fissure is a frequent entity that produces discomfort during and after defecation. Its pathophysiology is not clear and its management is varied. Lateral internal sphincterotomy is one of the most used techniques, although its high percentage of incontinence is not accepted; botulinum toxin injection is therefore a tempting alternative. Objective: To compare the results of botulinum toxin type A injection or lateral internal sphincterotomy for treatment of anal fissure in terms of postoperative pain, recurrence, healing and incontinence. Methods: A cohort study was carried out. One group of 40 patients were treated with injection of 50 IU of botulinum toxin type A and another group of 42 patients underwent lateral internal sphincterotomy. The results were statistically compared with a confidence interval of 95 percent and error of 0.05. Results: Sphincterotomy and botulinum toxin were effective in terms of healing in 85.4 percent and 77.5 percent of cases, respectively. Recurrences occurred in 4.8 percent and 12.5 percent of cases, respectively. Incontinence occurred in 9.5 percent and 2.5 percent of cases, respectively. Postoperative pain was present in 14.8 percent and 5.0 percent of cases, respectively. Conclusions: Sphincterotomy was better in terms of healing and recurrence, while botulinum toxin application showed better results regarding fecal incontinence and postoperative pain(AU)

Chinese expert consensus on clinical diagnosis and treatment of anal fissure (2021 edition) / 中华胃肠外科杂志

Anal fissure is a common anorectal disease, with anal pain as the main manifestation. Severe anal pain can affect the quality of life of patients. In clinical practice, there are some controversies about the treatment of anal fissure, especially the surgical indications. Improper surgical procedures will even cause anal incontinence. However, consensus opinions on anal fissure have not yet been formulated in China. On the basis of summarizing research progress in this field at home and abroad, combined with expert experience, and according to the principle of evidence-based medicine, the Clinical Guidelines Committee has organized experts in this field to form an expert consensus with 13 recommendations on diagnosis, evaluation and treatment of anal fissure for clinicians' reference.

A new theory on the cause of anal fissure - impaction theory / Uma nova teoria sobre a causa da fissura anal - teoria da impactação

ABSTRACT The internal hemorrhoid, rectal tumor, hypertrophic anal papilla, and secret fecal mass are regarded as the blocks embedded in the rectum. The above blocks hinder defecation, which will inevitably lead to excessive opening of the anal caliber. Once the limit is exceeded, the skin of the anal canal will tear and form anal fissure. Based on the study of historical evolution, hypothesis reasoning, clinical verification and comparison with other theories, a new concept of anal fissure etiology-impaction theory is proposed. The so-called impaction theory refers to the impaction (various primary lesions) in anorectum, which hinders defecation. When defecating, the anal canal expands beyond the limit, and the whole layer of anal canal skin splits, that is to say, anal fissure is formed.

RESUMO A hemorroida interna, o tumor retal, a papila anal hipertrófica e a massa fecal secreta são considerados os blocos incrustados no reto. Os bloqueios acima impedem a defecação, o que inevitavelmente levará a uma abertura excessiva do calibre anal. Uma vez que o limite é excedido, a pele do canal anal rasga e forma uma fissura anal. Com base no estudo da evolução histórica, raciocínio de hipóteses, verificação clínica e comparação com outras teorias, um novo conceito de etiologia da fissura anal - a teoria da impactação - é proposto. A chamada teoria da impactação refere-se à impactação (várias lesões primárias) no anorreto, o que dificulta a defecação. Na defecação, o canal anal se expande além do limite e toda a camada da pele do canal anal rasga, ou seja, forma-se a fissura anal.

Fisura anal: anatomía, patogenia y tratamiento / Anal fissure - anatomy, pathogenesis and treatment

RESUMEN La fisura anal es una patología proctológica frecuente caracterizada por un desgarro oval en el anoder mo que, si bien es pequeño, puede producir mucho dolor y angustia en el paciente. La etiología exacta aún se discute, pero está relacionada con una hipertonía del esfínter anal en la mayoría de los casos. El tratamiento inicial es médico, con fármacos que disminuyen el tono del esfínter anal. Las fisuras cróni cas generalmente requieren tratamiento quirúrgico. La esfinterotomía interna lateral tiene un elevado porcentaje de éxito y se considera el tratamiento de referencia. En este artículo haremos una revisión de la anatomía, fisiopatología y opciones terapéuticas actuales de las fisuras anales.

ABSTRACT Anal fissure is a common anorectal condition. While it often presents as a small oval tear in the anoderm, it can cause significant pain and anguish to the patient. The exact etiology is still debatable but increased anal tone is associated with most fissures. The initial management is medical with agents intended to reduce the anal tone. More chronic fissures usually require surgical intervention. Lateral internal sphincterotomy has a high success rates and is considered the gold standard of interventions. In this article we review the relevant anatomy, pathophysiology and contemporary treatment options for anal fissures.

Single centre randomized comparative trial of lateral internal sphincterotomy versus 2% diltiazem in chronic anal fissure

Background: Anal fissures are often encountered in surgical practice with surgery the gold standard management for chronic anal fissures. Recently the widespread use of pharmacologic agents for chronic fissures has increased. In our study we compare topical 2% diltiazem with lateral sphincterotomy with respect to symptoms such as relief of pain, ulcer healing, and side effects of treatments.Methods: A prospective comparative study, a total of 80 patients were randomized into 2 groups 40 each. Group A patients were subjected to open internal lateral sphincterotomy and group B to 2% topical diltiazem. The patients in both groups were followed up at 1st, 4th, 14th weeks and 6 months in OPD and were assessed for pain, sphincter tone and complications.Results: In group A (lateral anal sphincterotomy), patients achieved a good pain relief with a mean pain score of 1.98 by one week post procedure whereas group B (2% diltiazem) had taken 14 weeks to achieve similar pain relief (pain score of 1.5). At the end of 6 months, healing of fissure was noted in 100% of group A and in 90% of group B. 4 patients (10%) had recurrences in group B. Flatus incontinence was reported in 2 patients (5%) in group A although transient.Conclusions: Lateral anal sphincterotomy is superior to 2% diltiazem especially in healing of fissure, pain relief, quality of life and recurrence. Pharmacologic agents should be reserved for patients who are unfit or unwilling for surgery or can be used as a bridge therapy till sphincterotomy can be planned.

Comparative study of closed versus open lateral internal sphincterotomy in the management of chronic anal fissure

Background: Anal fissure is a painful tear in distal anal canal extending from just below the dentate line to anal verge. Patient presents with pain during or after defecation and passage of bright red blood per anus. Various studies investigating chronic anal fissures show a large variation in healing rates for different modalities. The present study was carried out to evaluate effectiveness of closed versus open lateral internal sphincterotomy in treatment of patients with chronic anal fissure.Methods: A prospective study was conducted in the Department of Surgery, Pt. B.D. Sharma PGIMS, Rohtak. Group A and group B included 20 patients each with chronic anal fissure and managed by closed and open lateral internal sphincterotomy respectively and effectiveness was evaluated with regards to fissure healing, pain reduction, recurrence and incontinence after surgical treatment.Results: The mean pain scores on visual analogue scale at end of 1 week in group A and group B was not found to be statistically significant, whereas it was found to be statistically significant at 3 week and at 6 weeks. Delayed healing was seen in 1 patient of group B, whereas no patient in group A had delayed healing or absence of healing postoperatively.Conclusions:There was a significant difference between closed and open methods of lateral internal sphincterotomy in terms of relief in post-operative pain but as a whole both techniques did not show any statistically significant difference in terms of fissure healing, postoperative complications or recurrence at 3 months.

Is open lateral anal sphincterotomy really a safe and satisfactory treatment option for refractory chronic anal fissures? - a prospective study

Background: Chronic anal fissure is a familiar entity in surgical outdoor departments of hospitals in our valley. The muslim women are usually reluctant to expose their anal canal related pathologies to male surgeons, letting anal fissures to reach the chronic stage. Under this background, the present study was conducted to look for the feasibility of lateral anal sphincterotomy in the management of chronic anal fissure in our patients.Methods: This prospective study was carried out over a period of 3 years in the unit 2nd of department of surgery at SMHS (Shri Maharaja Harisingh) hospital, an associated hospital of Government Medical College Srinagar. During this period, 59 patients presented to the outpatient department with typical chronic anal fissures and were included in this study.Results: Fifty-nine patients, diagnosed on clinical evaluation as chronic anal fissure were included in this study. The age varied from 19 to 58 years with mean age of 36.38±7.14 (SD= 7.14) years. There was a female predominance, with a female to male ratio of 2.1:1. Fifty-two (88.1%) patients had posterior midline fissure and 7 (11.8%) patients had an anterior anal fissure. Thirty-one patients were not satisfied with the conservative treatment and insisted for surgical management. All 31 patients were managed by open lateral anal sphincterotomy.Conclusions: Lateral anal sphincterotomy (LAS) is a safe and effective method of management for chronic refractory anal fissures. The complications are minimal and negligible.

The Difference between Conventional Lateral Internal Sphincterotomy vs One Step Controlled Sphincterotomy as a Treatment for Chronic Anal Fissure

Objective: In this study our main goal is to evaluate thedifference between conventional lateral internal sphincterotomyvs one step controlled sphincterotomy as a treatment forchronic anal fissure.Method: This quasi experimental study was carried out atdifferent Private Hospital, in Dhaka City from November 2008to October 2010 where 85 patients were included in this study.Grouping was done non randomly. Informed consent wasobtained from all patients after explanation of the nature of analfissure and possible treatment.Result: During the study, bleeding per rectum was found in 35(77.8%) in Group A (conventional group) and 30 (75.0%) inGroup B (one step controlled group).In Group A (conventionalgroup) pain was relived in mean 5.0(SD 3.8) (range 2-14) daysand in Group B (one step controlled group) pain was relived inmean 1.9(SD 1.2) (range 1-7) days. Which was statisticallysignificant (p<0.05).Conclusion: From our results; we can conclude that, one stepcontrolled lateral internal sphincterotomy is comparativelybetter than conventional technique which serves much moreconvenient treatment for chronic anal fissure. Further study isneeded for better outcome.

Evaluation of outcomes in fissurectomy and V-Y advancement flap for the treatment of chronic anal fissure / Avaliação de desfechos na fissurectomia e retalho de avanço em V­Y para o tratamento de fissura anal crônica

ABSTRACT Chronic anal fissure is difficult to treat. Surgery is usually recommended in the case of drug therapeutic failure. Fecal incontinence in patients with weaker sphincters (multipara older patients with a history of pelvic surgery etc.) is a major reason for rejecting surgery. Such these patients should be underwent fissurectomy and V-Y advancement flap in which sphincterotomy is not required. In this prospective study, we determined the outcomes and complications of fissurectomy and V-Y advancement flap in both groups of patients with low and high anal sphincter tones.

RESUMO A fissura anal crônica tem tratamento difícil. A cirurgia geralmente é recomendada em caso de falha do tratamento medicamentoso. A incontinência fecal em pacientes com esfíncteres mais fracos (pacientes multíparas mais velhas com história de cirurgia pélvica etc.) é uma razão importante para a rejeição da cirurgia. Esses pacientes devem ser submetidos a fissurectomia e retalho de avanço em V-Y no qual a esfincterotomia não é necessária. Neste estudo prospectivo, determinamos os desfechos e complicações da fissurectomia e o retalho de avanço em V-Y em ambos os grupos de pacientes com tônus baixo e alto do esfíncter anal.

Long-term Outcome of a Fissurectomy: A Prospective Single-Arm Study of 50 Operations out of 349 Initial Patients

PURPOSE: The surgical standard of care for patients with chronic anal fissure is still disputed. We aimed to assess the natural course of idiopathic anal fissure and the long-term outcome of a fissurectomy as a surgical treatment. METHODS: All consecutive patients referred to a single expert practitioner in a tertiary centre were primarily included. A fissurectomy was proposed in cases of refractory symptoms after 4 to 6 weeks of standard medical management. Only patients with idiopathic and noninfected anal fissures were included in this second subsample to undergo surgery. Conventional postoperative management was prescribed for all patients who had undergone surgery. The main outcome measures were the success rate (defined as a combination of wound healing and relief of pain) and postoperative anal continence. RESULTS: Three hundred forty-nine patients were primarily recruited. Fifty patients finally underwent surgery for an idiopathic and noninfected fissure. Among them, 47 (94%) were cured at the end of primary follow-up, and 44 of the 47 (93.6%) could be confirmed as being sustainably cured in the longer-term follow-up. The mean time of complete healing was 10.3 weeks (range, 5.7–36.4 weeks). All patients were free of pain at weeks 42. The continence score after surgery was not statistically different from the preoperative score. CONCLUSION: A fissurectomy for the treatment of patients with an idiopathic noninfected fissure is associated with rapid pain relief and a high success rate even though complete healing may often be delayed. Moreover, it appears to have no adverse effect on continence.

The comparative study between the topical preparations of diltiazem versus the nifedipine in treatment of anal fissure / 国际药学研究杂志

Background: Anal fissure is condition in which there are cut or tear in the distal anal cavity that associated with the spasm of the muscle of the internal anal sphincter. Simply anal fissure can be treated with simple measures through increase fibers intakes, laxatives, in addition to having a lots of drinks and in cases that not respond to these measures we use some topical preparations include CCBs, steroids, anesthetics. Aim: Topical CCBs mostly given for treatment of chronic anal fissures as it consider effective nonsurgical treatment for anal fissure and there are more than one CCBs including diltiazem and nifedipine to be used in treatment of anal fissure therefore this study was done in order to compare between these two drugs in term of their efficacy and tolerability. Method: In this study there are 65 patients was selected and interviewed during their visits to consultation clinics in Thi-Qar and distributed randomly between the two groups (Diltiazem group) and (Nifedipine group) as they use the drugs for 2 months topically for the perianal region the end point of this study was the healing within the predetermined period (3 months) and also made comparison for the tolerability between the 2 groups. Results: The healing rate with Nifedipine topical was higher significantly when compared with Diltiazem topical while in term of tolerability was there are no significant differences between the two groups the most common adverse effects that founded in the two group was perianal itching and burning sensation in the anal area. Conclusion: Availability of more than one topical from of CCBs for treatment of anal fissure needed to be investigated and according to the above results show that superiority for the topical nifedipine over diltiazem in treatment of anal fissure due to the higher rate of healing while in term of tolerability was no significant differences between them.

Comparative study of glyceryl trinitrate ointment versus surgical management of chronic anal fissure

Background: Fissures are common, but are often confused with other anal conditions, such as haemorrhoids. Fissures are usually caused by trauma to the inner lining of the anus from a bowel movement or other stretching of the anal canal. Aim: This study evaluated the efficacy of 0.2% glyceryl trinitrate versus lateral internal sphincterectomy in treatment of chronic anal fissure. Materials and Methods: This was a study which included 80 patients between November 2014 to September 2017. In this study, based on computer generated randomization, the patients were divided into two groups. Group A consisted of 40 patients with chronic anal fissure who were treated with 0.2% glyceryl trinitrate ointment, which was applied twice daily for 5 weeks. Group B included 40 patients who were treated by lateral internal sphincterotomy. Results: The mean duration of symptoms was 15.35±10.87 weeks in group A, it was 15.02±11.7 weeks in group B. Mean pain score during defecation was 7.89±1.58 in group A, it was 7.52±2.41 in group B. Bleeding during defecation was observed in 82% of patients in group A, 75% of patients in group B. Constipation was present in 27 patients i.e. 67% in group A and it was present in 31 patients i.e. 77% in group B. In Group A, 36 (90%) patients had posterior midline fissure, 4 (10%) had anterior midline fissure, In group B, 40 (100%) had posterior midline fissure. In group A, 24 (60%) had anal tag, in group B, 22 (56%) had anal tag. The VAS score in both the groups decreased gradually but the decrease was more in group B compared to group A at the end of 7th week which was statistically significant (p<0.05). Hence, the number of patients who had pain relief after surgical treatment was statistically significant as compared to patients who were treated with 0.2% glyceryl trinitrate ointment Awais Ghori, Bhooma Reddy M, Rajendra Prasad. Comparative study of glyceryl trinitrate ointment versus surgical management of chronic anal fissure. IAIM, 2017; 4(12): 188-194. Page 189 application. At the end of the 1st week, none of the patients were healed completely. But at the end of the 4th , in group A, only 14 patients were completely healed, 38 patients were completely healed in group B. At the end of the 7th week, all patients in group B were healed i.e. 100% were healed and in group A, 32 patients were healed completely. Conclusion: Chemical treatment by applying glyceryl trinitrate is also advantageous in that it doesn’t cause any complications. Surgical treatment by lateral sphincterotomy is most effective when patients fail to respond to chemical treatment.

Acupoint catgut embedding therapy in treatment of anal fissure at Ⅰ and Ⅱ stages:a randomized controlled trial / 中国针灸

<p><b>OBJECTIVE</b>To evaluate the difference in the clinical therapeutic effects on anal fissure at Ⅰ and Ⅱ stages between the acupoint catgut embedding therapy and western medication.</p><p><b>METHODS</b>Sixty patients of anal fissure at Ⅰ and Ⅱ stages were randomized into an embedding therapy group and a western medication group, 30 cases in each one. In the embedding therapy group, the acupoint catgut embedding therapy was applied at bilateral Tianshu (ST 25), Changqiang (GV 1), bilateral Chengshan (BL 57) and Tigangxue (Extra), once a week. In the western medication group, the external inunctum on the wound was given with 0.2% nitroglycerin ointment, once every morning and evening a day. The treatment lasted for 4 weeks continuously in the two groups. The follow-up visit was done for 3 months after treatment. The visual analogue scale (VAS) and anal pain duration were observed and recorded before treatment and on the 3rd day and the 7th day of treatment separately. The clinical therapeutic effects were compared between the two groups.</p><p><b>RESULTS</b>After treatment, on the 3rd day and the 7th day of treatment, VAS score and anal pain duration were all reduced significantly as compared with those before treatment in the patients of the two groups (all<0.01). The differences in the embedding therapy gruop were better than those in the western medication group before and after treatment (<0.01,<0.05). In the 2nd and 4th weeks after treatment, the clinical therapeutic effects in the embedding therapy group were better than those in the western medication group (both<0.05). In 3-month follow-up, the recurrent case in the embedding therapy group was one, and the recurrent case in the western medication group was six.</p><p><b>CONCLUSIONS</b>The acupoint catgut embedding therapy is safe and effective in the treatment of anal fissure at Ⅰ and Ⅱ stages and its recurrent case is lower as compared with the treatment of western medication.</p>

Clinical research on Huang Bai capsules combined with Chinese medicine fumigation on the treatment of chronic anal fissure / 中国生化药物杂志

Objective To research the effect of Huang Bai capsules combined with Chinese medicine fumigation on treatment of chronic anal fissure.Methods 84 patients with chronic anal fissure from the second hospital of Shandong from January 2014～June 2016 were divided into two groups randomly.The control group was treated with Nitroglycerin and Lining gel and the observation group was treated with Huang Bai capsules combined with Chinese medicine fumigation.Treatment efficacy,symptom improvement,VAS score,gap healing time,ARP and RRP were compared between the two groups.Results The total effective rate in the observation group 95.24％is higher than that in the control group 78.57％(P<0.05).The proportion of bleeding and constipation after treatmen were lower than that before treatment(P<0.05).The proportion of bleeding and constipation in the observation group(9.52％and 11.90％)were lower than those in the control group(28.57％and 33.33％)(P<0.05).③ VAS score and gap healing time in the observation group were(1.18±0.20)points and(14.92±2.05)days,which were better than those in the control group(2.39±0.22)points and(19.16±2.28)days(P<0.05).④ARP and RRP in the observation group were(7.88±0.40)kPa and(2.61±0.31)kPa,which were lower than those in the control group(8.59±0.55)kPa and(3.09±0.45)kPa(P<0.05).Conclusion It can speed up crack healing and improve the effect of patients with anal fissure which Huang Bai capsules combined with Chinese medicine fumigation were used in the treatment.

Comparison of the effect of the longitudinal joints and anal fissure excision in the treatment of anal fissure / 中国基层医药

Objective To compare the clinical effect of surgery with longitudinal incision and transverse suture in the treatment of anal fissure excision of anal fissure.Methods 60 patients with anal fissure who required surgery were selected,and they were randomly divided into two groups according to the digital table.30 patients in the control group received anal fissure resection,30 cases in the observation group received anal fissure longitudinal incision and transverse suture treatment.The clinical curative effect was compared between the two groups.Results The effective rate of the control group was 93.33％,which of the observation group was 96.67％,there was no significant difference between the two groups (P ＞ 0.05).The postoperative pain score of the control group was (3.89 ±1.30) points,which of the observation group was (1.33 ± 1.20) points,there was significant difference between the two groups(t =8.449,P＜ 0.05).The incidence rate of complication of the control group was 6.67％,which of the observation group was 23.33％,there was significant difference between the two groups (x2 =9.524,P ＜ 0.05).Conclusion The surgical treatment of anal fissure,surgery and excision of anal fissure anal fissure joints have advantages and disadvantages according to the treatment of transverse slitting,the specific patient should select the specific surgical methods.