[Pathology of the anal region and its care in proctologic practice]

The anal dermis, with its sensitive receptors, is an important part of the anorectal apparatus. Anal fissures and perianal phlebothrombosis can cause considerable pain. According to anatomical diagnostics, there are three clear stages in the development of an anal fissure. At the first stage, a treatment using a glass dilator gives good results. The subsequent two stages, however, require surgery. In current practice there are two types of operation: the association of a fissurectomy with dorsal sphincterotomy under local or general anaesthetic; or fissurectomy associated with an inferior lateral sphincterotomy, a technique improved by Notaras. A comparison between the two types of treatment shows that fissurectomy associated with lateral sphincterotomy constitutes the more effective method. As the rate of recidivism and complications is the same, the operation can be performed on an ambulatory basis during hours of consultation. Thrombectomy under local anaesthetic may be used for the treatment of perianal phlebothrombosis in its most critical phases. This always relieves the patient's pain, and it, too, may be performed on an ambulatory basis.