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Anal fissure. 20-year experience
C Oh1, C M Divino, R M Steinhagen
1Department of Surgery, Mount Sinai Medical Center, New York, New York, USA.
Diseases of the Colon and Rectum
|April 1, 1995
Summary
Surgical treatment for chronic anal fissures offers over 95% symptom relief. Open lateral internal sphincterotomy is recommended for intractable cases, while hygiene is key for prevention and initial management.
Area of Science:
- Colorectal surgery
- Gastroenterology
- Surgical outcomes
Background:
- Anal fissures are common anorectal conditions.
- Chronic fissures often require surgical intervention.
- Understanding etiologic factors is crucial for effective management.
Purpose of the Study:
- To review a 20-year surgical experience with anal fissure treatment.
- To identify potential etiologic factors.
- To explore preventative measures and optimal treatment strategies.
Main Methods:
- Retrospective review of 1,391 patients (1972-1991) with chronic anal fissures.
- Surgical procedures included internal sphincterotomy, C-anoplasty, debridement, and sphincter excision.
- Acute fissures were managed conservatively with emphasis on hygiene.
Main Results:
- Conservative management was effective for acute superficial fissures.
- Over 95% of surgically treated chronic fissures achieved satisfactory symptom relief.
- Complication rates were higher with closed versus open sphincterotomy.
Conclusions:
- Anal hygiene is vital for fissure prevention and conservative treatment.
- Open lateral internal sphincterotomy is the preferred treatment for chronic, intractable fissures.
- C-anoplasty and sphincter excision are indicated for specific anal canal abnormalities.