You are here

Home » Content

ANAL FİSSÜRLERDE MEDİKAL TEDAVİ

Journal Name:

  • Cerrahpaşa Tıp Dergisi

Publication Year:

  • 2004

Key Words:

Keywords (Original Language):

Author NameUniversity of AuthorFaculty of Author
Abstract (2. Language): 
Fissure-in-ano or anal fissure is a linear longitudinal defect in the lining of the anal canal extending usually from the dentate line to the anal verge. Anal fissures affect all age groups, but predominantly occur in youngs and otherwise healthy adults. Although, most anal fissures are acute and relatively short-lived, resolving spontaneously, those persist and require intervention cause considerable morbidity. Recent researches to the physiology and pharmacology of the internal anal sphincter has elucidated the importance of this structure in health and disease. Current investigations consider raised resting pressure of internal sphincter and ischemia in posterior midline of anal canal as primary factors in the appearance and maintenance of this lesion. Much work has gone into the development of new pharmacological agents that can promote healing of anal fissures by production of a reversible chemical sphincterotomy. Recent innovations that have largely replaced surgery as first line treatment for anal fissure and the literature about these current treatment modalities has been reviewed.
Bookmark/Search this post with
Abstract (Original Language): 
Fissura in-ano veya anal fissür anal kanalda genellikle Linea Dentatadan anal vergeye ka-dar uzanan anal kanal mukozasındaki defekttir. Anal fissürler tüm yaş gruplarını etkilese de çoğunlukla sağlıklı gençlerde ve sağlıklı eriş-kinlerde görülürler. Her ne kadar anal fissürle-rin çoğu akut ve nispeten geçici olup spontan düzelse de, inatçı ve müdahale gerektirenler bir hayli morbiditeye neden olurlar. Internal sfink-terin fizyolojisi ve farmakolojisine yönelik son çalışmalar bu yapının sağlıkta ve hastalıktaki önemini ortaya koymuştur. Güncel çalışmalar bu lezyonun görülmesi ve devamında primer faktörler olarak internal sfinkterin istirahat basıncının yükselmiş olması ve anal kanalın posterior orta hattaki iskemiyi ortaya koymuştur. Yeni farmakolojik ajanlarla ilgili çalışmalar sonucu geçici şimik sfinktero-tomi yapılarak anal fissür tedavisi sağlanmıştır. Çalışma Dizaynı: Anal fissürün ilk tedavi-sinde büyük oranda cerrahinin yerini alan son gelişmeler ve geçerli tedavi modaliteleri ile il-gili literatürler gözden geçirildi. Efektif olarak şimik sfinkterotomiyi sağla-yan ve birçok fissürün iyileşmesine neden olan farmakolojik ajanların keşfi hastaların yaklaşık 2/3’ünün cerrahiden kaçınmasını sağlamıştır. Bu ilaçların çoğunun kısa sürede yüksek oran-da yan etkileri mevcuttur. Fakat klinik dene-melerle çoğu ilacın optimum dozları, doz ara-lıkları ve ilaçların uygulamada izlenecek yol henüz anlaşılmıştır. Ayrıca bu medikal mani-pulasyonların tüm hastalara uygulanıp uygula-namayacağı açık değildir. Anal fissür tedavisi hastanın klinik profiline özel olmalıdır, özellik-le yan etkilerin görülmesi kullanımlarını sınır-lar ve bu ajanlar fissürün iyileşmesinde her za-man etkili değildir. Bununla birlikte bu deza-vantajlara rağmen, akut ve kronik anal fissür-lerde mükemmel ilk basamak tedavisi olmuş-lardır. Ayrıca şimik sfinkterotomi özellikle inf-lamatuar barsak hastalığı, sifiliz, immün siste-min zayıfladığı virüs enfeksiyonlu (HIV enfek-siyonunu kapsayan) hastalarda uygundur. Medikal tedavinin başarılı olmadığı durum-larda veya nüks fissürlerde cerrahi tedavi endi-kasyonu mevcuttur.
FULL TEXT (PDF): 
PDF icon arastirmax-anal-fissurlerde-medikal-tedavi.pdf
  • 4
194-199
  • Turkish

REFERENCES

References: 

1. Lockhart Mummery JP. Diseases of the rectum and colon and their surgical treatment. Toronto: Mac Millan, 1934
CERRAHPAŞA TIP DERGİSİ Cilt (Sayı) 35 (4)
198
2. Bennett R.C., Goligher JC. Results of internal sphincterotomy for anal fissure. BMJ: 1962; 2: 1500-3
3. Lund JN, Scholefield JH. Aetiology and treatment of anal fissure.Br J Surg. 1996; 83: 1335-44
4. Griffin N., Acheson A.G., Tuna P., Sheard C., Glazebrak C., Scholefield J.H. Quality of life in patients with chronic anal fissure. Colorectal Dis. 2004; 6: 39-44
5. Keighley M.R.B., Williams N.S. Fissure-in-ano, Surgery of the anus, rectum and colon, Vol-1, 3rd ed. W.B.Saunders, London, 1993; 13: 428-55
6. Graham-Stewart CW, Greenwood RK, Lloyd-Davies RW. Review of 50 patients with fissure-in-ano Surg. Gynaecol Obstetr. 1961; 113: 445-48
7. Flesher PR, Schoetz DJ Jr., Roberts P.L. Murrau J.J., Coller J.A. Anal fissure in Crohn’s disease: A plea for aggressive treatment. Dis Colon Rectum 1995; 38: 1137-43
8. Jonas M.,Scholefield J.H. Anal Fissure. Gastroenterol. Clin. N.Am. 2001; 30: 167-181
9. Martin JD. Postpartum anal fissure. Lancet; 1953; 271-3
10. Lock MR, Thompson JPS. Fissure-in-ano: The initial management and prognosis Br J.Surg. 1977; 64: 355-58
11. Mazier W.P. Hemorrhoids, fissures and pruritis ani Surg. Clin. N.Am.1994; 74: 1277-92
12. Arabi Y., Alexander-Williams J., Keighley MRB. Anal pressures in hemorrhoids and anal fissures. Am J.Surg. 1977; 134: 608-16
13. Keck J.O., Staniunas RJ, Coller JA., Barrett RC. Oster ME Computer generated profiles of the anal canal in patients with anal fissure. Dis Colon Rectum 1995; 38: 72-9
14. Klosterhalfen B., Vogel P., Rixen H., Mittermayer C. Topography of the inferior rectal artery: A possible cause of chronic anal fissure. Dis Colon Rectum 1989; 32: 43-52
15. Shouten, WR Briel J.W, Auwerda JJA. Relationship between anal pressure and anodermal blood flow Dis Colon Rectum 1994; 37: 664-9
16. Frezza, EE, Sandie F., Leoni G.Biral M. Conservative and surgical treatment in acute and chronic anal fissure: A study on 308 patients Int J.Colorect Dis 1992; 7: 188-191
17. Das Gupta R., Franklin I, Pitt J, Dawson PM. Successful treatment of chronic anal fissure with diltiazem gel Colorectal Dis. 2002; 4: 20-2
18. Jensen SL. Treatment of first episodes of acute anal fissure: Prospective randomized study of lignocaine ointment versus hydrocortisone ointment or warm sitz baths plus bran BMJ 1986; 292: 1167-69
19. Graziano A., Suidler-Lopez L., Lencinas S., Masciangioli G. Gualdrini U. Bissisio O. Long-term results of topical nitroglucerine in the treatment of chronic anal fissures are disappointing. Tech Coloproctol 2001; 5: 143-7
20. Hasegawa H., Radley S., Morton D.G., Dorricott NJ., Campell DJ. Audit of topical glyceryl trinitrate for treatment of fissure-in-ano Ann R Coll Surg Enal. 2000; 82: 27-30
21. Dorfnan G, Levitt M., Platell C. Treatment of chronic anal fissure with topical glyceryl trinitrate. Dis Colon Rectum 1999; 42: 1007-10
22. Kennedy ML, Sowter S. Nguyen H, et al. Glyceryl trinitrate oinment for the treatment of chronic anal fissure. Results of a placebu – controlled trial and long-term follow-up Dis Colon Rectum 1999; 42: 1000-6
23. Chaudhuri S. Pal A.K., Ackaua A., Dey A., Chowdhurg A., Santra A. Treatment of chronic anal fissure with topical glyceryl trinitrate: A double-blind, placebo-controlled trial Indian J.Gastroenterol 2001; 20: 101-2
24. Scholefield J.H, Bock J.U, Marla B. Richter HJ, Athenasiadis S., et al. A dose finding study with 0,1%, 0,2% and 0,4% glyceryl trinitrate ointment in patients with chronic anal fissures. Gut 2003; 52: 264-9
25. Bailey HR, Beck D.E., Billingham RP, Bindrerow SR et al. A study to determine the nitroglycerine oinment dose and dosing interval that promote the healing of chronic anal fissures. Dis Colon Rectum 2002; 45: 1192-9
26. Cook TA., Humphreys MM et al. Oral nifedipine reduces resting anal pressure and heals chronic anal fissure. Br J Surg 1999; 86: 1269-73
27. Ezri T., Susmallion S. Topical nifedipine vs topical glyceryl trinitrate for treatment of chronic anal fissure. Dis Colon Rectum 2003; 46: 805-808
28. Perrotti P. Bove A., Antropoli C., Molino D., Antropoli M., Balzano A., De Stefano G., Attena F. Topical nifedipine with lidocaine oinment vs active control for treatment of chronic anal fissure: Results of a prospective randomized double-blind study Dis Colon Rectum 2002; 45: 1468-75
29. Jonas M., Neal KR., Abercrombie JF., Scholcfield J.H. A randomized trial of oral vs topical diltiazem for chronic anal fissures. Dis Colon Rectum 2001; 44: 1074-8
30. Griffin N, Acheson AG, Jonas M, Scholefield JH. The role of topical diltiazem in the treatment of chronic anal fissures that have failed glyceryl trinitrate therapy Colorectal Dis. 2002; 4: 430-5
31. Ansaloni L, Bernabe A, Ghetti R, Riccardi R. Tranchino RM Oral lacidipine in the treatment of anal fissure. Tech Coloproctol 2002; 6: 79-82
32. Acheson AG. Griffin N, Scholefield JH, Wilson WG. L-Arginine-induced relaxation of the internal anal sphincter
Ekim-Aralık 2004 ANAL FİSSÜRLERDE MEDİKAL TEDAVİ; ERSAN VE ARK.
199
is not mediated by nitric oxide. Br J Surg 2003; 90: 1155-62
33. Pitt J, Dawson PM, Halan Rİ, Boulos PP. A double-blind randomized placebo-controlled trial of oral. Indoramine to treat chronic anal fissures. Colorectal Dis 2001; 3: 165-8
34. Pitt J, Ojo-Aromokudu MD, Craggs MD. The role of alpha and beta adrenoceptors in chronic fissure-in-ano, Colorectal Dis 1999; 1: 55-9
35. Jost WH. One hundred case of anal fissure treated with botulin toxin: Early and long-term results. Dis Colon Rectum 1997; 40: 1029-32
36. Maria G, Birisinda G, Bentivoglio AR, Cassetta E, Gui D, Albenesse A. Botulinum toxin injections in the internal anal sphincter for the treatment of chronic anal fissure: Long term results after two different dosage regimens. Ann Surg 1998; 228: 664-9
37. Lindsey I, Jones OM, Gunningham C, George BD, Mortensen NJ. Botulinum toxin as second-line theraphy for chronic anal fissure failing 0,2 percent glyceral trinitrate Dis Colon Rectum 2003; 46: 361-6

Thank you for copying data from http://www.arastirmax.com