Background: we previously assessed the efficacy of different medical and surgical treatments for chronic anal fissure (CAF). In this prospective audit we present longer-term results of this study in a larger series.Patients and Methods: From 01/04 to 09/08, 294 patients with typical CAF were enrolled. All patients were treated with 0.2% nitroglycerin ointment (GTN) or anal dilators (DIL) for 8 weeks. Those patients in which no improvement in symptoms was observed after 8 weeks were crossed to the other treatment (GTN or DIL) or switched to a combination of the two. Persisting symptoms after 12 weeks or recurrence were indications for either botulinum toxin injection into the internal sphincter and fissurectomy (BTX) or LIS. Primary end-point was fissure healing at last follow-up. Secondary end-points were symptomatic improvement, need for lateral internal sphincterotomy (LIS), and side effects. Differences between treatment groups were evaluated by chi square test. Results: patients' demographics, fissure characteristics and treatment results are resumed in Table 1. Mean follow-up was 36±17 months. Recurrence rate after 12 weeks treatment was similar between GTN and DIL (11.5% vs 9.3%). Overall fissure healing after medical treatment was 69.7% without significant differences between GTN (57.2%), DIL (66.9%) or a combination of the two (59.5%). Side effects (GTN) or severe discomfort (DIL) were observed in 13.2% of the patients. Thirty patients were treated with BTX and 64 underwent LIS (including BTX failures). At the end of the follow-up healing rates were 83.3% after BTX and 100% after LIS. No morbidity or postoperative incontinence were observed in both surgical groups.Conclusions: This study confirms that LIS is far more effective than medical treatments for CAF. However, BTX injection/fissurectomy as first line treatment may significantly increase the healing rate while avoiding any risk of incontinence. Table 1: patients' demographics, fissure characteristics and treatment results. GTN DIL GTN/DIL BTX/Fissurectomy LIS Number 173 121 42 30 64 Mean Age (years) 41 43 43 38 45 Sex (M/F) 80/93 52/69 28/14 11/19 27/32 Fissure position Ant 19 18 8 2 15 Post 145 97 32 26 47 Both/other 9 6 2 2 2 Single treatment (12 weeks) success N/% 95/173 (54.9%) 75/121 (61%) NA NA NA Recurrence 11/95 (11.5%) 7/75 (9.3%) NA NA NA After cross-over healing N/% 20/50 (40%) 16/32 (50%) 17/42 (40.4%) NA NA Recurrence 5/20 (25%) 3/16 (18.7%) 4/17 (23.5%) NA NA Overall success N/% 99/173 (57.2%) 81/121 (66.9%) 25/42 (59.5%) 25/30 (83.3%) 64/64 (100%) NA= not applicable

Sileri, P., Stolfi, V.m., Venza, M., Grande, M., D’Ugo, S., D’Eletto, M., et al. (2009). MEDICAL AND SURGICAL TREATMENT OF CHRONIC ANAL FISSURE: PROSPECTIVE LONG-TERM RESULTS. In Abstracts.

MEDICAL AND SURGICAL TREATMENT OF CHRONIC ANAL FISSURE: PROSPECTIVE LONG-TERM RESULTS

SILERI, PIERPAOLO;STOLFI, VITO MARIA;GRANDE, MICHELE;GASPARI, ACHILLE
2009-01-01

Abstract

Background: we previously assessed the efficacy of different medical and surgical treatments for chronic anal fissure (CAF). In this prospective audit we present longer-term results of this study in a larger series.Patients and Methods: From 01/04 to 09/08, 294 patients with typical CAF were enrolled. All patients were treated with 0.2% nitroglycerin ointment (GTN) or anal dilators (DIL) for 8 weeks. Those patients in which no improvement in symptoms was observed after 8 weeks were crossed to the other treatment (GTN or DIL) or switched to a combination of the two. Persisting symptoms after 12 weeks or recurrence were indications for either botulinum toxin injection into the internal sphincter and fissurectomy (BTX) or LIS. Primary end-point was fissure healing at last follow-up. Secondary end-points were symptomatic improvement, need for lateral internal sphincterotomy (LIS), and side effects. Differences between treatment groups were evaluated by chi square test. Results: patients' demographics, fissure characteristics and treatment results are resumed in Table 1. Mean follow-up was 36±17 months. Recurrence rate after 12 weeks treatment was similar between GTN and DIL (11.5% vs 9.3%). Overall fissure healing after medical treatment was 69.7% without significant differences between GTN (57.2%), DIL (66.9%) or a combination of the two (59.5%). Side effects (GTN) or severe discomfort (DIL) were observed in 13.2% of the patients. Thirty patients were treated with BTX and 64 underwent LIS (including BTX failures). At the end of the follow-up healing rates were 83.3% after BTX and 100% after LIS. No morbidity or postoperative incontinence were observed in both surgical groups.Conclusions: This study confirms that LIS is far more effective than medical treatments for CAF. However, BTX injection/fissurectomy as first line treatment may significantly increase the healing rate while avoiding any risk of incontinence. Table 1: patients' demographics, fissure characteristics and treatment results. GTN DIL GTN/DIL BTX/Fissurectomy LIS Number 173 121 42 30 64 Mean Age (years) 41 43 43 38 45 Sex (M/F) 80/93 52/69 28/14 11/19 27/32 Fissure position Ant 19 18 8 2 15 Post 145 97 32 26 47 Both/other 9 6 2 2 2 Single treatment (12 weeks) success N/% 95/173 (54.9%) 75/121 (61%) NA NA NA Recurrence 11/95 (11.5%) 7/75 (9.3%) NA NA NA After cross-over healing N/% 20/50 (40%) 16/32 (50%) 17/42 (40.4%) NA NA Recurrence 5/20 (25%) 3/16 (18.7%) 4/17 (23.5%) NA NA Overall success N/% 99/173 (57.2%) 81/121 (66.9%) 25/42 (59.5%) 25/30 (83.3%) 64/64 (100%) NA= not applicable
The Society for surgery of the alimentary tract
Chicago, Illinois
2009
50th
Rilevanza internazionale
contributo
1-giu-2009
2009
Settore MED/18 - CHIRURGIA GENERALE
English
Intervento a convegno
Sileri, P., Stolfi, V.m., Venza, M., Grande, M., D’Ugo, S., D’Eletto, M., et al. (2009). MEDICAL AND SURGICAL TREATMENT OF CHRONIC ANAL FISSURE: PROSPECTIVE LONG-TERM RESULTS. In Abstracts.
Sileri, P; Stolfi, Vm; Venza, M; Grande, M; D’Ugo, S; D’Eletto, M; Di Giorgio, A; Gaspari, A
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2108/67637
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