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2007, Número 2

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Cir Gen 2007; 29 (2)


Fisura anal

Charúa GL

Idioma: Español
Referencias bibliográficas: 70
Paginas: 149-158
Archivo PDF: 190.83 Kb.


RESUMEN

Objetivo: Exponer los avances en el conocimiento y tratamiento de la fisura anal. Comprender su clasificación, sintomatología, tratamiento médico, tratamiento farmacológico y alternativas quirúrgicas.
Diseño: Revisión bibliográfica.
Material y métodos: Se consultaron las bases de datos Medline, Pubmed, Cochrane, EMBASE, Medigraphic con la palabra clave “Fisura anal” y se incluyeron revisiones sistemáticas, artículos originales y guías de manejo.
Resultados: El manejo estándar para curar la fisura anal crónica ha sido la esfinterotomía lateral interna parcial, pero el dolor postoperatorio, el costo hospitalario, el tiempo de incapacidad laboral y, sobre todo, la posibilidad de incontinencia fecal han promovido el desarrollo de medicamentos que eviten estos inconvenientes, entre los que destacan los nitratos tópicos, bloqueadores de canales de calcio y la toxina botulínica tipo A. La fisura anal con síntomas de leves a moderados debe ser manejada con cualquiera de las alternativas farmacológicas antes mencionadas, en especial con la toxina botulínica, que ha demostrado, en forma consistente, los mejores resultados. La fisura anal muy sintomática o con características de cronicidad es tributaria de tratamiento quirúrgico desde su diagnóstico.
Conclusión: El estándar de oro para el manejo de la fisura anal crónica muy sintomática sigue siendo la esfinterotomía lateral interna parcial.


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