eMedicine Specialties > Pediatrics: Surgery > General Surgery

Anal Fissure: Follow-up

Author: Brian P Gillett, MD, Assistant Professor, Department of Emergency Medicine, SUNY Downstate Medical Center and King, Department of Emergency Medicine, SUNY Downstate Medical Center and King
Coauthor(s): Charles N Paidas, MD, MBA, Professor of Surgery and Pediatrics, University of South Florida; Chief of Pediatric Surgery, Tampa General Hospital
Contributor Information and Disclosures

Updated: Dec 10, 2008

Outcome and Prognosis

In several small studies, chemical sphincterotomy using glyceryl-trinitrate (GTN) with adjunctive stool softeners has been demonstrated to be quite effective at relieving symptoms and promoting healing. However, most pediatric surgeons report equal success with open or closed lateral sphincterotomy for acute and chronic anal fissures. Recurrence rates of open or closed lateral sphincterotomy have been reported to be 0-10%, with most of the recurrences occurring in adults and with chronic fissures. In contrast, anal dilatations have the highest rates of fistula recurrence (10-30%) and, for this reason, are not recommended in children.

Large prospective series describing outcome in patients following surgical intervention for chronic anal fissure also are lacking in the literature. However, most authors report anal dilatation and lateral subcutaneous sphincterotomy both to be effective therapeutic interventions for chronic anal fissures.

Future and Controversies

The treatment of anal fissures has advanced significantly over the last decade. Local reconstruction with advancement flaps is a relatively new and effective adjunct to chronic fissure excision. Reversible chemical sphincterotomy is a promising development in the treatment of acute (and possibly chronic) anal fissures. Large prospective randomized trials comparing the efficacy of the agents within this latter treatment modality remain to be reported.

 


More on Anal Fissure

Overview: Anal Fissure
Workup: Anal Fissure
Treatment: Anal Fissure
Follow-up: Anal Fissure
References

References

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Further Reading

Keywords

anal fissure, fissure in ano, anal tear, tear of the squamous epithelial mucosa of the anal canal, tear of the anal canal, bright rectal bleeding, posterior midline tear, constipation, anorectal pain, passage of hard stool, blood in the stool, anorectal blood, rectal blood, rectal bleeding, anal skin tag, chronic ulcer, acquired immunodeficiency syndrome, chlamydia, gonorrhea, syphilis, neoplasm, sexual abuse, inflammatory bowel disease

Contributor Information and Disclosures

Author

Brian P Gillett, MD, Assistant Professor, Department of Emergency Medicine, SUNY Downstate Medical Center and King, Department of Emergency Medicine, SUNY Downstate Medical Center and King
Brian P Gillett, MD is a member of the following medical societies: Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Charles N Paidas, MD, MBA, Professor of Surgery and Pediatrics, University of South Florida; Chief of Pediatric Surgery, Tampa General Hospital
Charles N Paidas, MD, MBA is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Association for the Surgery of Trauma, American College of Surgeons, American Heart Association, American Pediatric Surgical Association, Association for Academic Surgery, Florida Pediatric Society, Johns Hopkins Medical and Surgical Association, Society of Critical Care Medicine, and Society of University Surgeons
Disclosure: Nothing to disclose.

Medical Editor

Aviva L Katz, MD, Assistant Professor of Surgery, University of Pittsburgh School of Medicine; Consulting Staff, Division of General and Thoracic Surgery, Children's Hospital of Pittsburgh
Aviva L Katz, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Surgeons, American Pediatric Surgical Association, Association of Women Surgeons, Physicians for Social Responsibility, and Wilderness Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

Gail E Besner, MD, John E Wilson Endowed Professor of Neonatal Research, Nationwide Children's Hospital; Professor of Surgery and Pediatrics, Department of Surgery, Ohio State University College of Medicine; Director, Pediatric Surgical Research, Department of Surgery, Nationwide Children's Hospital
Gail E Besner, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Burn Association, American College of Surgeons, American Gastroenterological Association, American Medical Association, American Medical Women's Association, American Pediatric Surgical Association, Association for Academic Surgery, Federation of American Societies for Experimental Biology, Society of Critical Care Medicine, Society of Surgical Oncology, and Society of University Surgeons
Disclosure: Trillium Therapeutics, Inc. Consulting fee Consulting; Trillium Therapeutics, Inc. Grant/research funds Other

CME Editor

H Biemann Othersen Jr, MD, Professor of Surgery and Pediatrics, Emeritus Head, Division of Pediatric Surgery, Medical University of South Carolina
H Biemann Othersen Jr, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Association for the Surgery of Trauma, American Burn Association, American Cancer Society, American College of Surgeons, American Medical Association, American Pediatric Surgical Association, American Society for Parenteral and Enteral Nutrition, American Surgical Association, American Thoracic Society, British Association of Paediatric Surgeons, Society for Surgery of the Alimentary Tract, Society of Critical Care Medicine, South Carolina Medical Association, Southeastern Surgical Congress, Southern Medical Association, Southern Society for Pediatric Research, and Southern Thoracic Surgical Association
Disclosure: Nothing to disclose.

Chief Editor

Philip Glick, MD, MBA, Professor, Departments of Surgery, Pediatrics, and Gynecology and Obstetrics, Vice-Chairperson for Research and Development, Department of Surgery, State University of New York at Buffalo
Philip Glick, MD, MBA is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American College of Surgeons, American Medical Association, American Pediatric Surgical Association, American Thoracic Society, Association for Academic Surgery, Association for Surgical Education, Central Surgical Association, Federation of American Societies for Experimental Biology, Medical Society of the State of New York, Phi Beta Kappa, Physicians for Social Responsibility, Royal College of Surgeons of England, Sigma Xi, Society for Pediatric Research, Society for Surgery of the Alimentary Tract, Society of Critical Care Medicine, and Society of University Surgeons
Disclosure: Nothing to disclose.

 
 
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