| | Treatments and success % |  May 12th 2008, 3:04 am by Fissulyna | Chemical sphincterotomy has been attempted using a wide range of agents, including nitric oxide and botulinum toxin. Since anal fissures are characterized by spasm of the internal anal sphincter and a reduction in mucosal blood flow, the aim of treatment is to relieve ischemia by reducing resting anal pressure and improving mucosal perfusion.
It has been shown that a local application of topical nitrates reduces anal sphincter pressure and improves anodermal blood flow. This dual effect results in fissure healing in more than 80% of patients. The principal side effect is headaches in 20%-100% of cases.
It has also been shown that local a local injection of botulinum toxin near the fissure, causes denervation, sphincter muscle weakness, and reduction of resting anal sphincter pressure, which allows the fissure to heal. Fissure healing occurs in more than 60% of patients. The principal side effect is incontinence of flatus and or feces, which last for up to two months in 2% to 21% of cases.
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Surgical Treatment
When surgical excision is required, the chronic fissure along with the sentinel pile, papilla, and adjacent crypts are dissected free from the underlying muscle. Associated internal and external hemorrhoids are removed. Usually the scar tissue in the posterior anal quadrant is completely denuded. The criteria for excision of fissures are chronicity and association with other anorectal disease such as hemorrhoids, mucosal prolapse, skin tags, enlarged papillae, anal contraction, and diseased crypts.
Sometimes, an anal dilation is performed to gently disrupt the scar tissue in the base of the fissure. Other times, cauterization by: laser, electrosurgical, or a chemical (i.e., silver nitrate) method; is used to simply denude or resurface the fissure base, to encourage the growth of new anal tissue.
Lateral partial internal sphincterotomy has been utilized for uncomplicated fissures. This surgery consists of a small operation to cut a portion of the anal muscle. This helps the fissure to heal by preventing pain and spasm, which interferes with healing. Cutting this muscle rarely interferes with the ability to control bowel movements.
At least 90% of patients who require surgery for this problem have no further trouble from fissures. More than 95% of patients achieve prolonged symptomatic improvement. About 5-percent of patients with fissures are "chronic fissure formers", and for a variety of reasons (i.e., chronic constipation, failure to heal without scar tissue, etc.), will continue to develop new fissures despite all the efforts of medical and surgical treatment.
| | Comments: 7 |
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| Poll |
| How was your recovery from surgery? | | I had a couple of days of pain, but healed / felt great within a couple of weeks. | | 26% | [ 4 ] | | I suffered for a week or so with pain, and took up to a month to feel back to normal. | | 33% | [ 5 ] | | I was in pain for about a month before I started any real signs of healing / getting back to normal. | | 20% | [ 3 ] | | I was in pain for 2 months or longer before I started any signs of healing / getting back to normal. | | 6% | [ 1 ] | | I have had the surgery and believe my AF never healed. | | 6% | [ 1 ] | | I have had the surgery, healed but had re-tear/s. | | 6% | [ 1 ] |
| | Total Votes : 15 |
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