eMedicine Specialties > Pediatrics: Surgery > General Surgery
Anal Fissure: Follow-up
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.
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| Overview: Anal Fissure |
| Workup: Anal Fissure |
| Treatment: Anal Fissure |
Follow-up: Anal Fissure |
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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
Follow-up: Anal Fissure