6533b86cfe1ef96bd12c8acf
RESEARCH PRODUCT
Surgical sphincter saving approach and topical nifedipine for chronic anal fissure with hypertonic internal anal sphincter
Gloria TerranovaSebastiano BonventreBeatrice D'orazioFausto FamàGuido MartoranaGiovanni CorboCarmelo SciumèDario CalìGirolamo GeraciGaetano Di Vitasubject
medicine.medical_specialtyLidocaineNifedipinemedicine.medical_treatmentAdministration TopicalAnal CanalSurgical FlapsInternal anal sphincterFissurectomyOintmentsMuscle HypertoniaNifedipineMuscle HypertoniamedicineHumansProspective StudiesAnesthetics LocalAnestheticsAnal fissureAnal fissure Anoplasty Fissurectomy Lidocaine Nifedipine Proctology Administration Topical Anal Canal Anesthetics Local Calcium Channel Blockers Chronic Disease Combined Modality Therapy Humans Lidocaine Muscle Hypertonia Ointments Prospective Studies Surgical Flaps Treatment Outcome Fissure in Ano Nifedipinebusiness.industryLidocaineAnal canalAnoplastymedicine.diseaseCalcium Channel BlockersCombined Modality TherapySurgerymedicine.anatomical_structureTreatment OutcomeTopicalLocalAdministrationChronic DiseaseHypertoniaSurgeryFissure in Anomedicine.symptomAnal fissureProctologyLateral internal sphincterotomybusinessmedicine.drugdescription
PURPOSE The role of augmented internal anal sphincter (IAS) tone in the genesis of posterior chronic anal fissure (CAPF) is still unknown. Lateral internal sphincterotomy is the most employed surgical procedure, nevertheless it is burdened by high risk post-operative anal incontinence. The aim of our study is to evaluate results of sphincter saving procedure with post-operative pharmacological sphincterotomy for patients affected by CAPF with IAS hypertonia. Methods: We enrolled 30 patients, undergone fissurectomy and anoplasty with V-Y cutaneous flap advancement; all patients received topical administration of nifedipine 0.3% and lidocaine 1.5% ointment-based therapy before and for 15 days after surgery. The primary goal was patient's complete healing and the evaluation of incontinence and recurrence rate; the secondary goal included the evaluation of manometry parameters, symptom relief and complications related to nifedipine and lidocaine administration. Results: All wounds healed within 40 days after surgery. We didn't observe any de novo postoperative anal incontinence case. We reported 2 cases of recurrences, healed after conservative therapy. We didn't report any local complications related to the administration of the ointment therapy; with whom all patients reported a good compliance. Conclusions: Fissurectomy and anoplasty with V-Y cutaneous advancement flap and topical administration of nifedipine and lidocaine, is an effective treatment for CAPF with IAS hypertonia.
| year | journal | country | edition | language |
|---|---|---|---|---|
| 2020-10-01 |