ABSTRACT
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)
Subject(s)
Humans , Pain, Postoperative , Botulinum Toxins, Type A/therapeutic use , Fissure in Ano/etiology , Lateral Internal Sphincterotomy/methods , Cohort StudiesABSTRACT
Background: Haemorrhoids are common pathology of anal canal. Over the last few years, because of new surgical techniques, increased attention has been laid on Surgical Management of hemorrhoids, still open Haemorrhoidectomy remains the mainstay of treatment. Postoperative pain is one of the most common complications of open Haemorrhoidectomy. In our study we decided to compare the incidence of postoperative pain in open Haemorrhoidectomy with or without lateral sphincterotomy. Methods: To compare the incidence of post-operative pain in patient of open Haemorrhoidectomy with lateral sphincterotomy versus open Haemorrhoidectomy without lateral sphincterotomy. Results: In our study group A in which open Haemorrhoidectomy along with lateral sphincterotomy was done had statistically significant less postoperative pain at 6 hours and 24 hours postoperatively and on postoperative day 7 at the time of follow up with Chi square test (P<0.0001). Conclusion: Addition of lateral sphincterotomy decreased post-operative pain and also reduced the need for post-operative analgesia in a significant number of patients. Hence through this study, we concluded that in conventional open Haemorrhoidectomy, addition of lateral sphincterotomy is an effective, convenient, and simple way to reduce post-operative pain.
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Objective To compare the clinical efficacy of two surgical methods for the treatment of anal fissures in elderly patients.Methods A total of 138 elderly patients with anal fissures treated at our hospital from January to December 2016 were randomly divided into the conventional method group(69 cases) and the modified method group (69 cases).Patients in the conventional method group were treated with lateral sphincterotomy,while patients in the modified method group were treated with modified longitudinal sphincterotomy with transverse suture.Outcomes of treatment,VAS scores,incision wound infection rates,postoperative voiding dysfunction rates and recurrence rates were compared.Results There was no significant difference in overall effectiveness between the modified method group (98.6％)and the conventional method group(94.2％) (x2=1.8677,P=0.1717).The rates of incision wound infection,moderate postoperative urinary retention and recurrence in the conventional method group(8.7％,42.0％ and 10.1 ％,respectively)were significantly higher than those in the modified methods group(0.0 ％,15.9 ％ and 0.0％,respectively) (x2 =4.3561,11.4061 and 5.4177,respectively,P =0.0369,0.0007 and 0.0199,respectively).At 12 hours after operation,favorable VAS scores and incision healing times were observed in the modified method group,compared with the conventional method group,and the differences were statistically significant(each P＜0.05).Conclusions Modified longitudinal sphincterotomy with transverse suture produces about the same overall effectiveness as does lateral sphincterotomy in the treatment of elderly patients with anal fissures,but it is superior in reducing incision wound infection,moderate postoperative voiding dysfunction,recurrence and pain intensity,and in promoting incision healing.
ABSTRACT
Background: Surgical management is used for the treatment of most of the fissures including manual anal dilation or performing lateral sphincterotomy. The present study carries a comparative research between the patients posted for lateral internal sphincterotomy and application of 2% Diltiazem gel in chronic anal fissure. Methods: The study was conducted in Department of General Surgery, Teerthankar Mahaveer Medical College & Research Centre from May 2015 to April 2016. After informed written consent, 60 patients were enrolled in the study. All patients were allocated in two groups; Group S (30 patients) posted for Lateral Sphincterotomy and Group D (30 patients) consisting of 2 % Diltiazem gel therapy. Results: Out of 30 patients, 3 lost during the follow up period in Group D. 19 patients (63.33%) had complete healing at the fissure site upon application of Diltiazem (2%) gel at 4 week follow up. In case of Group S, 26 patients (86.67%) had complete healing of fissure at 4 weeks follow up while 2 patients had complete healing at 8 week follow up visit. 22 (73.33%) of the patients treated with diltiazem (2%) gel were pain free at the end of 4 weeks. 27 (90.00%) out of 30 patients undergoing lateral internal sphincterotomy were free from pain at the end of 4 weeks post operatively. Conclusion: Lateral internal Sphincterotomy is the first line of treatment in patients for the chronic fissure in ano.