ABSTRACT
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)
Subject(s)
Humans , Female , Adult , Middle Aged , Aged , Botulinum Toxins, Type A/therapeutic use , Dose-Response Relationship, Drug , Pain, Postoperative , Fecal Incontinence , Fissure in Ano/surgeryABSTRACT
PURPOSE: Our aim was to evaluate the effectiveness of combining a fissurectomy with a botulinum toxin A injection in treating chronic anal fissure. METHODS: A single surgeon in Saudi Arabia conducted a nonrandomized prospective cohort study between October 2015 and July 2020. The cohort included 116 female patients with chronic anal fissures with a mean age of 36.57±11.52 years who have presented to the surgical outpatient clinic and received a botulinum toxin injection A combined with fissurectomy. They were followed up with for at least 1, 2, 3, 4, and 8 weeks to evaluate the effects of the treatment, then again at 1 year. Primary outcome measures were symptomatic relief, complications, recurrence, and the need for further surgical intervention. RESULTS: Treatment with botulinum toxin A combined with fissurectomy was effective in 99.1% of patients with chronic anal fissure at 1 year. Five patients experienced recurrences at 8 weeks which resolved completely with a pharmacological sphincterotomy. Twelve patients experienced minor incontinence which later disappeared. Pain completely disappeared in more than half of the patients (55.2%) within 7 to 14 days. Pain started to improve in less than 8 days among patients treated with a dose of 50±10 IU (P=0.002). CONCLUSION: Seventy units of botulinum toxin A injection combined with a fissurectomy is a suitable second-line treatment of choice for chronic anal fissure, with a high degree of success and low rate of major morbidity.
ABSTRACT
The entero-atmospheric fistula (EAF) is a recognized complication of open abdomen surgeries, which causes significant morbidity and mortality. This usually causes long hospitalizations and may require many surgical operations. While different methods of treatment for EAF are used, all different methods share the same goal, which is a proper closure of the fistula and the open abdomen to avoid recurrence and complications. We report a case of a 48-year-old female with a bowel perforation following an attempted open bilateral ovarian cyst drainage with cyst wall biopsy complicated by entero-atmospheric fistula treated by wound closure with vacuum-assisted pressure. In conclusion, the use of vacuum-assisted closure (VAC) to induce spontaneous healing of EAFs can provide a safe acceptable alternative to surgical treatment.
