In:
coloproctology, Springer Science and Business Media LLC, Vol. 42, No. 2 ( 2020-04), p. 90-196
Abstract:
Anal fissure is one of the most common pathologies presenting to the coloproctologist. Reliable guidelines giving recommendations on diagnosis and treatment are needed. The present guidelines have been developed by a multinational and multidisciplinary panel of experts. The board discussed up-to-date scientific knowledge around anal fissure, on the basis of a thorough and systematic review of the available literature. Acute anal fissures often heal spontaneously. They should therefore be treated conservatively in the first instance, by intake of high-fiber diet and/or use of topical agents with a relaxing effect on the internal anal sphincter (e. g. calcium channel antagonists (CCA)). Patients suffering from chronic anal fissure (CAF) should be offered a trial of “chemical sphincterotomy” by topical application of CCA/nitrates or alternatively injections of botulinum toxin. However, the most efficient treatment option for CAF is the surgical approach. Operative interventions can be offered as primary therapy or in recurrent/persisting anal fissures after failed medical therapy. Fissurectomy +/− Botulinum toxin injection or an anal advancement flap are recommended as first line operations in view of a low risk for faecal incontinence, although the lateral internal sphincterotomy shows quicker symptom relief and excellent fissure healing rates, at the price of a higher postoperative incontinence risk.
Type of Medium:
Online Resource
ISSN:
0174-2442
,
1615-6730
DOI:
10.1007/s00053-020-00448-7
Language:
German
Publisher:
Springer Science and Business Media LLC
Publication Date:
2020
detail.hit.zdb_id:
2023514-8
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