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Sacral nerve stimulation: a novel treatment of chronic anal fissure
Alexander Yakovlev1, Sergey A Karasev, Oleg Y Dolgich
1Comprehensive Pain Management of the Fox Valley, Appleton, WI, USA. aeyakovlev@yahoo.com
Objective:
The purpose of this pilot study of 5 patients was to test the feasibility of a new treatment approach for chronic anal fissure utilizing minimally invasive sacral nerve stimulation before designing and conducting a larger prospective controlled study.
Measurements:
The patients underwent uneventful placement of one temporary 8-electrode Octad lead for sacral nerve root stimulation. Stimulation was conducted for 20 minutes 3 times per day. The lead was removed after 3 weeks of stimulation.
Results:
The patients experienced an immediate improvement in perineal pain after the initiation of sacral nerve stimulation. The pain relief effect lasted 10 to 12 hours, so stimulation was conducted for short episodes to ensure patient comfort and to extend the battery life of the external neurostimulator. For all patients, the chronic anal fissure healed by the end of the third week of temporary sacral nerve stimulation. There was no recurrence of anal fissure 1 year after treatment in all of the study participants.
Conclusion:
Sacral nerve stimulation offers an effective alternative treatment option for chronic anal fissure in patients who chose not to pursue more invasive surgical interventions.
