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Revista Mexicana de Coloproctología Enfermedades del Ano, Recto y Colon

2006, Number 1

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Rev Mex Coloproctol 2006; 12 (1)

Anal fissure

Hequera JA, Obregón GJ

Language: Spanish
References: 104
Page: 19-32
PDF size: 342.08 Kb.


ABSTRACT

Anal fissure is a benign condition characterized by pain, generally located at the posterior midline, with positive results to medical treatment in most cases, and the need of surgery in the event they become chronic. Goals: A retrospective analysis of anal fissure was conducted to discuss medical treatment results, the cases when surgery was necessary, and the complications derived from it, using a recent personal casuistry. Population and method: Retrospective studies of 60 patients treated both at private offices and in the hospital between January 2001 and December 2005. Fifteen of which were referred to our group to perform surgery due to medical treatment failure. There were 32 women (53%) and 28 men (47%). The average age was 38 years old, ranking from 27 a 63. 58 patients (97%) suffered from posterior fissures and 2 (3%) from anterior ones. Forty five patients were treated with nitroglycerin ointments (ntg), warm sitz baths with mallow and high fiber diets, avoiding coffee, alcoholic beverages, fried food, strong species, chocolate and tobacco. 25 patients had surgery (15 referrals and 10 due to failure of nitroglycerin treatment). Fifteen (72%) had lateral internal sphincterotomy (LIS) and 7 (28%) uderwent a Sarner kind of surgery. Two sphincterotomy and 1 Sarner were performed in recurrence. Results: 35 out of 45 patients (78%) healed and no recurrences were reported until now. Among the patients who underwent LIS, 3 suffered mild and short term incontinence to gas, 4 delayed healing (2 to 3 months) and there were 3 recurrences operated with positive results. Among the patients who underwent Sarner surgery there were no recurrences (followed between 3 years and 5 months). Analysis: Positive answers to medical treatment prioritize this alternative in severe anal fissure. Chronic fissure or lack of response to medical treat ment requires any of the different surgical treatment approaches. Conclusion: Our experience shows that treatment of severe anal fissure with NTG resulted in nearly 80% of patients healed. LIS was successful in most of the cases with rare, short term or mild complications.


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