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Faecal Incontinence
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
P. Ronan O’Connell, Thomas Dudding
Lateral internal sphincterotomy for anal fissure can lead to faecal incontinence, especially if the entire length of the internal anal sphincter is divided, as originally described by Eisenhammer.46 The majority of patients with anal fissures are found to have a hypertonic IAS. It is hypothesised that this leads to impaired blood flow in the microvasculature of the anal mucosa, which prevents healing of the fissure. Topical treatments using nitric oxide donors and calcium channel blockers, such as GTN and Diltiazem, and chemical sphincterotomy using botulinum toxin, aim to reduce resting pressure and increase mucosal blood flow. In patients in whom these conservative treatments fail, or in those that have recurrent relapsing disease, a lateral internal anal sphincterotomy may be considered.
Anal Fissure
Published in P Ronan O’Connell, Robert D Madoff, Stanley M Goldberg, Michael J Solomon, Norman S Williams, Operative Surgery of the Colon, Rectum and Anus Operative Surgery of the Colon, Rectum and Anus, 2015
Botulinum toxin is preferred by some surgeons in the primary treatment of anal fissures, while others use it to treat fissures that have not responded to topical GTN or diltiazem. However, the success rates are variable and randomized trials have failed to show a significant benefit for one non-surgical treatment over another. It is the authorʹs view that there is an overall failure rate of 20–40 percent with non-surgical treatment and that, in these cases, a well-performed lateral internal sphincterotomy will resolve the patient’s symptoms in the vast majority of cases without long-term side effects.
Anal Fissure
Published in Laurence R. Sands, Dana R. Sands, Ambulatory Colorectal Surgery, 2008
Miguel del Mazo, Laurence R. Sands
The options available today for anal fissure are quite varied. In addition, there have been many publications on the various techniques. The internet has also allowed patients to become better informed regarding their medical conditions and treatment options. Patients now present to the physician’s office fearful of what they have read regarding incontinence associated with sphincterotomy. While the patient needs to be well informed, it is also the physician’s responsibility to provide proper counseling as to the best treatment options for the patient. When conservative options have been exhausted, surgical options need to be considered. Lateral internal sphincterotomy continues to be the procedure of choice for chronic anal fissure and may be performed with excellent overall results.
Fistulectomy and primary sphincteroplasty (FIPS) to prevent keyhole deformity in simple anal fistula: a single-center retrospective cohort study
Published in Acta Chirurgica Belgica, 2021
Nicolas De Hous, Thomas Van den Broeck, Charles de Gheldere
The importance of keyhole deformity after fistulotomy is underestimated, even though it is a well-known complication of anorectal surgery [4]. The condition has only been described to a very limited extent in the current literature. The few available publications only mention its occurrence after surgery for chronic anal fissure, most notably lateral internal sphincterotomy [4,14]. Keyhole deformity is largely neglected by both surgeons and patients because the complaints related to the fistula of fissure (anal pain, discharge) are resolved after the operation and the deformity itself can be asymptomatic. When symptomatic, patients usually present with complaints of pruritus or soiling (due to stasis of faeces in the deformity), which can be misinterpreted as fecal incontinence [4,15].
Botulinum toxin injection is an effective alternative for the treatment of chronic anal fissure
Published in Acta Chirurgica Belgica, 2023
The main problem in CAF is internal anal sphincter (IAS) spasm, which causes local ischemia due to prolonged compression in the anodermal arteries passing through the IAS. Therefore, the purpose of CAF treatment is to reduce IAS spasm and improve blood flow [1,3,5–8]. Lateral internal sphincterotomy (LIS) has been the gold standard treatment for CAF treatment. However, despite the high healing rates and low recurrence rates after LIS, the subsequent high incontinence rates have caused researchers to look for an alternative [1,3,6,8–12].
The Role of Pudendal Nerve Block in Colorectal Surgery: A Systematic Review
Published in Journal of Investigative Surgery, 2021
Michael G. Fadel, Laura Peltola, Gianluca Pellino, Gabriela Frunza, Christos Kontovounisios
The majority of the literature describe using PNB for patients undergoing open or closed haemorrhoidectomy [3, 5, 17, 24–29, 31, 32]. Alkhadi et al. [1] reports the use of a PNB for lateral internal sphincterotomy for chronic anal fissure. Kim et al. [30] describes the use of the PNB for benign colorectal diseases treated surgically such as condylomata, fissure lateral subcutaneous sphincterotomy or fissurectomy), fistula, abscess, tumor and hemorrhoids.