Skip to main content

Tailoring Therapy for Recurrent Anal Fissure

  • Chapter
  • First Online:
  • 2679 Accesses

Abstract

There are real concerns regarding continence outcome after lateral internal anal sphincterotomy in selected patients. In patients with persistent symptomatic fissure after definitive surgery, the risks to continence are particularly real. This chapter outlines the place for various sphincter-sparing surgical alternatives when conventional surgery fails.

This is a preview of subscription content, log in via an institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   219.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   279.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Griffin N, Acheson AG, Tung P, Sheard C, Glazebrook C, Scholefield JH. Quality of life in patients with chronic anal fissure. Colorectal Dis. 2004;6:39–44.

    Article  PubMed  CAS  Google Scholar 

  2. Schouten WR, Briel JW, Auwerda JJ, Boerma MO. Anal fissure: new concepts in pathogenesis and treatment. Scand J Gastroenterol Suppl. 1996;218:78–81.

    Article  PubMed  CAS  Google Scholar 

  3. Schouten WR, Briel JW, Auwerda JJ, De Graaf EJ. Ischaemic nature of anal fissure. Br J Surg. 1996;83:63–5.

    Article  PubMed  CAS  Google Scholar 

  4. Jensen SL. Maintenance therapy with unprocessed bran in the prevention of acute anal fissure recurrence. J R Soc Med. 1987;80:296–8.

    PubMed  CAS  Google Scholar 

  5. Lund JN, Nyström PO, Coremans G, Herold A, Karaitianos I, Spyrou M, et al. An evidence-based treatment algorithm for anal fissure. Tech Coloproctol. 2006;10:177–80.

    Article  PubMed  CAS  Google Scholar 

  6. Lund JN, Scholefield JH. A randomised, prospective, double-blind, placebo-controlled trial of glyceryl trinitrate ointment in treatment of anal fissure. Lancet. 1997;349(9044):11–4.

    Article  PubMed  CAS  Google Scholar 

  7. Lindsey I, Jones OM, Cunningham C, Mortensen NJ. Chronic anal fissure. Br J Surg. 2004;91:270–9.

    Article  PubMed  CAS  Google Scholar 

  8. Cook TA, Humphreys MM, McC Mortensen NJ. Oral nifedipine reduces resting anal pressure and heals chronic anal fissure. Br J Surg. 1999;86:1269–73.

    Article  PubMed  CAS  Google Scholar 

  9. Ezri T, Susmallian S. Topical nifedipine vs. topical glyceryl trinitrate for treatment of chronic anal fissure. Dis Colon Rectum. 2003;46:805–8.

    Article  PubMed  Google Scholar 

  10. Madoff RD, Fleshman JW. AGA technical review on the diagnosis and care of patients with anal fissure. Gastroenterology. 2003;124:235–45.

    Article  PubMed  Google Scholar 

  11. Nelson R. Non surgical therapy for anal fissure. Cochrane Database Syst Rev. 2006;(4):CD003431

    Google Scholar 

  12. Lund JN, Scholefield JH. Aetiology and treatment of anal fissure. Br J Surg. 1996;83:1335–44.

    Article  PubMed  CAS  Google Scholar 

  13. Collins EE, Lund JN. A review of chronic anal fissure management. Tech Coloproctol. 2007;11:209–23.

    Article  PubMed  CAS  Google Scholar 

  14. American Gastroenterological Association medical position statement. Diagnosis and care of patients with anal fissure. Gastroenterology. 2003;124:233–4.

    Article  Google Scholar 

  15. Cross KL, Massey EJ, Fowler AL, Monson JR. The management of anal fissure: ACPGBI position statement. Colorectal Dis. 2008;10 Suppl 3:1–7.

    Article  PubMed  Google Scholar 

  16. Perry WBD, Sharon L, Buie DW, Rafferty JF. On behalf of the Standards Practice Task Force of the American Society of Colon and Rectal Surgeons. Practice Parameters for the Management of Anal Fissures (3rd Revision). Dis Colon Rectum. 2010;53:1110–5.

    Article  PubMed  Google Scholar 

  17. Nelson R. Anal fissure (chronic). Clin Evid (Online). 2007;pii:0407.

    Google Scholar 

  18. Lund JN, Scholefield JH. Internal sphincter spasm in anal fissure. Br J Surg. 1997;84:1723–4.

    Article  PubMed  CAS  Google Scholar 

  19. AbdElhady HM, Othman IH, Hablus MA, Ismail TA, Aboryia MH, Selim MF. Long-term prospective randomised clinical and manometric comparison between surgical and chemical sphincterotomy for treatment of chronic anal fissure. S Afr J Surg. 2009;47:112–4.

    CAS  Google Scholar 

  20. Lund JN, Scholefield JH. Follow-up of patients with chronic anal fissure treated with topical glyceryl trinitrate. Lancet. 1998;352(9141):1681.

    Article  PubMed  CAS  Google Scholar 

  21. Gagliardi G, Pascariello A, Altomare DF, Arcanà F, Cafaro D, La Torre F, et al. Optimal treatment of glyceryl trinitrate (GTN) for chronic anal fissure (CAF): results of a prospective randomized trial. Tech Coloproctol. 2010;14:241–8.

    Article  PubMed  CAS  Google Scholar 

  22. Casillas S, Hull TL, Zutshi M, Trzcinski R, Bast JF, Xu M. Incontinence after a lateral internal sphincterotomy: are we underestimating it? Dis Colon Rectum. 2005;48:1193–9.

    Article  PubMed  Google Scholar 

  23. Hyman N. Incontinence after lateral internal sphincterotomy: a prospective study and quality of life assessment. Dis Colon Rectum. 2004;47:35–8.

    Article  PubMed  Google Scholar 

  24. Menteş BB, Tezcaner T, Yilmaz U, Leventoğlu S, Oguz M. Results of lateral internal sphincterotomy for chronic anal fissure with particular reference to quality of life. Dis Colon Rectum. 2006;49:1045–51.

    Article  PubMed  Google Scholar 

  25. Sultan AH, Kamm MA, Hudson CN, Thomas JM, Bartram CI. Anal-sphincter disruption during vaginal delivery. N Engl J Med. 1993;329:1905–11.

    Article  PubMed  CAS  Google Scholar 

  26. Sultan AH, Kamm MA, Nicholls RJ, Bartram CI. Prospective study of the extent of internal anal sphincter division during lateral sphincterotomy. Dis Colon Rectum. 1994;37:1031–3.

    Article  PubMed  CAS  Google Scholar 

  27. Zbar AP, Aslam M, Allgar V. Faecal incontinence after internal sphincterotomy for anal fissure. Techn Coloproctol. 2000;4:25–8.

    Article  Google Scholar 

  28. Ammari FF, Bani-Hani KE. Faecal incontinence in patients with anal fissure: a consequence of internal sphincterotomy or a feature of the condition? Surgeon. 2004;2:225–9.

    Article  PubMed  CAS  Google Scholar 

  29. Zbar A, Beer-Gabel M, Chiappa AC, Aslam M. Fecal incontinence after minor anorectal surgery. Dis Colon Rectum. 2001;44:1610–23.

    Article  PubMed  CAS  Google Scholar 

  30. Jost WH, Aoki KR. Botulinum toxin A in anal fissure: why does it work? Dis Colon Rectum. 2004;47:257–8.

    Article  PubMed  Google Scholar 

  31. Jost WH, Schimrigk K. Use of botulinum toxin in anal fissure. Dis Colon Rectum. 1993;36:974.

    Article  PubMed  CAS  Google Scholar 

  32. Jost WH. Ten years’ experience with botulin toxin in anal fissure. Int J Colorectal Dis. 2002;17:298–302.

    Article  PubMed  Google Scholar 

  33. Brisinda G, Cadeddu F, Brandara F, Marniga G, Maria G. Randomized clinical trial comparing botulinum toxin injections with 0.2 per cent nitroglycerin ointment for chronic anal fissure. Br J Surg. 2007;94:162–7.

    Article  PubMed  CAS  Google Scholar 

  34. Brown SR, Matabudul Y, Shorthouse AJ. A second case of long-term incontinence following botulinum injection for anal fissure. Colorectal Dis. 2006;8:452–3.

    Article  PubMed  CAS  Google Scholar 

  35. Nelson R. Anal fissure (chronic). Clin Evid (Online). 2010;pii:0407.

    Google Scholar 

  36. Baraza W, Boereboom C, Shorthouse A, Brown S. The long-term efficacy of fissurectomy and botulinum toxin injection for chronic anal fissure in females. Dis Colon Rectum. 2008;51:239–43.

    Article  PubMed  Google Scholar 

  37. Mousavi SR, Sharifi M, Mehdikhah Z. A comparison between the results of fissurectomy and lateral internal sphincterotomy in the surgical management of chronic anal fissure. J Gastrointest Surg. 2009;13:1279–82.

    Article  PubMed  CAS  Google Scholar 

  38. Witte ME, Klaase JM, Koop R. Fissurectomy combined with botulinum toxin A injection for medically resistant chronic anal fissures. Colorectal Dis. 2010;12:e163–9.

    Article  PubMed  CAS  Google Scholar 

  39. Farouk R, Monson JRT, Duthie GS. Technical failure of lateral sphincterotomy for the treatment of chronic anal fissure: a study using endoanal ultrasonography. Br J Surg. 2005;84:84–5.

    Google Scholar 

  40. Littlejohn DR, Newstead GL. Tailored lateral sphincterotomy for anal fissure. Dis Colon Rectum. 1997;40:1439–42.

    Article  PubMed  CAS  Google Scholar 

  41. Menteş BB, Ege B, Leventoglu S, Oguz M, Karadag A. Extent of lateral internal sphincterotomy: up to the dentate line or up to the fissure apex? Dis Colon Rectum. 2005;48:365–70.

    Article  PubMed  Google Scholar 

  42. Bove A, Balzano A, Perrotti P, Antropoli C, Lombardi G, Pucciani F. Different anal pressure profiles in patients with anal fissure. Techn Coloproctol. 2004;8:151–7.

    Article  CAS  Google Scholar 

  43. Mentes BB, Güner MK, Leventoglu S, Akyürek N. Fine-tuning of the extent of lateral internal sphincterotomy: spasm-controlled vs. up to the fissure apex. Dis Colon Rectum. 2008;51:128–33.

    Article  PubMed  Google Scholar 

  44. Rosa G, Lolli P, Piccinelli D, Mazzola F, Zugni C, Ballarin A, et al. Calibrated lateral internal sphincterotomy for fissure. Techn Coloproctol. 2005;9:127–32.

    Article  CAS  Google Scholar 

  45. Giordano P, Gravante G, Grondona P, Ruggiero B, Porrett T, Lunniss PJ. Simple cutaneous advancement flap anoplasty for resistant chronic anal fissure: a prospective study. World J Surg. 2009;33:1058–63.

    Article  PubMed  Google Scholar 

  46. Patti R, Fama F, Tornambe A, Restivo M, Di Vita G. Early results of fissurectomy and advancement flap for resistant chronic anal fissure without hypertonia of the internal anal sphincter. Am Surg. 2010;76:206–10.

    PubMed  Google Scholar 

  47. Pascual M, Pares D, Pera M, Courtier R, Gil MJ, Puig S, et al. Variation in clinical, manometric and endosonographic findings in anterior chronic anal fissure: a prospective study. Dig Dis Sci. 2008;53:21–6.

    Article  PubMed  Google Scholar 

  48. Zbar AP. Sphincter-sparing surgical alternatives for chronic anal fissure: the place of fissurotomy. Dis Colon Rectum. 2008;51:1299.

    Article  PubMed  Google Scholar 

  49. Pelta AE, Davis KG, Armstrong DN. Subcutaneous fissurotomy: a novel procedure for chronic fissure-in-ano. A review of 109 cases. Dis Colon Rectum. 2007;50:1662–7.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jonathan N. Lund BMedSci (Hons), BMBS, DM, FRCS (Gen) .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer-Verlag London

About this chapter

Cite this chapter

Lund, J.N. (2013). Tailoring Therapy for Recurrent Anal Fissure. In: Zbar, A., Madoff, R., Wexner, S. (eds) Reconstructive Surgery of the Rectum, Anus and Perineum. Springer, London. https://doi.org/10.1007/978-1-84882-413-3_40

Download citation

  • DOI: https://doi.org/10.1007/978-1-84882-413-3_40

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-84882-412-6

  • Online ISBN: 978-1-84882-413-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics