China
Africa
Explore chapters and articles related to this topic
Postanal Repair
Published in Han C. Kuijpers, Colorectal Physiology: Fecal Incontinence, 2019
The essential anatomical pivot to the operation is the identification of the avascular plane (the intersphincteric space) which exists between the cylinder composed of the involuntary musculature of the internal anal sphincter and rectum and the cylinder of striated muscle comprising the pelvic floor and external anal sphincter (Figure 1). Some surgeons have learned to recognize the differing lower borders of the internal/external anal sphincter muscles during the procedure of the internal anal sphincterotomy. Further dissection within the plane, however, takes a certain amount of skill and experience and thereby represents the chief difficulty in the technique. If the anatomy is not clear and the rectum is injured, serious pelvic sepsis may be the inevitable outcome.
Gastrointestinal bleeding
Published in Michael JG Farthing, Anne B Ballinger, Drug Therapy for Gastrointestinal and Liver Diseases, 2019
Matthew R Banks, Peter D Fairclough
The current pharmacological regimens favoured include topical application of glycerine trinitrate (GTN) ointment and botulinum toxin A injection of the internal anal sphincter (Table 4.3). Surgery involves a lateral internal anal sphincterotomy, which results in good healing rates (90%); however, incontinence occurs in up to 45% in the early postoperative period and is permanent in 8%.15 GTN is a donor of nitric oxide (NO), a neurotransmitter that has been shown to be a potent relaxant of vascular and intestinal smooth muscle. Recent trials have shown an 8-week course of 0.2% topical GTN three times daily is effective for over two-thirds of patients with chronic anal fissures.16 Healing has been shown to be associated with a reduction in the maximum resting anal pressure and higher GTN doses appear to accelerate resolution. The recurrence rate of fissures after GTN treatment, however, is up to one in three, but these can often be treated successfully with repeated courses.
Colon, rectum and anus
Published in Michael Gaunt, Tjun Tang, Stewart Walsh, General Surgery Outpatient Decisions, 2018
Surgery is required both to exclude more serious conditions (fissure biopsy) and to speed recovery. Operation consists of examination under anaesthetic (rectal examination, sigmoidoscopy and biopsy if indicated) and lateral internal anal sphincterotomy (healing rates of up to 85–95%, but incontinence to flatus in up to 35%). Uncontrolled manual anal dilatation (the four finger stretch) is no longer recommended due to the unacceptably high risk of sphincter injury.
Potential combination topical therapy of anal fissure: development, evaluation, and clinical study†
Published in Drug Delivery, 2018
Amgad E. Salem, Elham A. Mohamed, Hosam M. Elghadban, Galal M. Abdelghani
Internal anal sphincterotomy has been used to heal the anal fissures through lowering the resting anal pressure. Yet, surgical risks and late permanent incidence of incontinence are the main complications during the post-operative period (Haq et al. 2005). Hence, alternative therapy regimens are necessary for the treatment of anal fissure. Chemical sphincterotomy has been induced by different agents including botulinum toxin, glyceryl trinitrate, and calcium channel blockers, such as diltiazem and nifedipine (NIF) (Perrotti et al. 2002). Use of topical nitrates is hindered by headache reported in as many as 90% of patients as well as orthostatic hypotension due to possible vasodilatation following systemic absorption (Bulus et al. 2013).