NEW method of treating fissures !!!!

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NEW method of treating fissures !!!!

Postby Fissulyna » 19 Apr 2008, 12:56

Arie E. Pelta1, Kurt G. Davis1 and David N. Armstrong1
(1) Georgia Colon & Rectal Surgical Clinic, 5555 Peachtree Dunwoody Road, Suite 206, Atlanta, Georgia, USA
Published online: 22 August 2007
Abstract
Purpose The constant presence of a narrow subcutaneous tract extending caudad to chronic fissures-in-ano is reported. The efficacy of surgically unroofing this tract (subcutaneous fissurotomy) without sphincterotomy was evaluated.
Methods By using a narrow-gauge, hooked probe, a constant, midline subcutaneous tract was identified extending from the caudad aspect of chronic anal fissures. These tracts are present within the sentinel tag, when present, and extend up to 1 cm caudad to the fissure in the subcutaneous plane. A proximal connection with the dentate line in the submucous plane also was identified. Surgically unroofing the tract (subcutaneous fissurotomy) resulted in significant widening of the distal anal canal, rendering internal sphincterotomy unnecessary. A 32-month prospective evaluation of this new technique was performed. Inclusion criteria included patients with chronic anal fissures that had failed conservative therapy, including topical agents. In each case, the tract was identified and surgically laid open along its entire length. No internal sphincterotomy was performed in any patient. Postoperatively, patients were instructed to apply topical 10 percent metronidazole t.i.d. The need for repeat surgery and/or subsequent internal sphincterotomy was recorded.
Results A total of 109 patients were enrolled during the study period. Median follow-up was 12 months. During the study period, two patients (1.8 percent) required repeat surgery for persistent symptoms at 3 and 12 months postoperatively. No change in continence was reported in any patient.
Conclusions Laying open the subcutaneous tract has a very high success rate and a low incidence of repeat surgery. This finding introduces a new debate relating to the etiology of fissure-in-ano and makes routine internal sphincterotomy unnecessary.
Key words Anal fissure - Fissure - Chronic fissure - Fissurotomy - Fissurectomy - Internal sphincterotomy
Dr. Armstrong has a patent licensing agreement with SLA Pharma AG for topical 10 percent metronidazole.
Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, St. Louis, Missouri, June 2 to 6, 2007.
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Re: NEW method of treating fissures !!!!

Postby Guest » 19 Apr 2008, 14:03

If this is the person I am thinking of I think he was a partner of my last CRS in Atlanta.
Very interesting!

She had me use metronidazole on my incision from the hemorrhoid surgery but it was too irritating for me to continue.
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Re: NEW method of treating fissures !!!!

Postby Fissulyna » 19 Apr 2008, 15:09

How interesting !!! What kind of medicine is Metronizadle ?
How are you doing today, buddy ??? :_):
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Re: NEW method of treating fissures !!!!

Postby Guest » 19 Apr 2008, 15:23

It is an antibacterial compound with a petroleum base. You can have mine if you want it!

I am doing better today, how about you?
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Re: NEW method of treating fissures !!!!

Postby Jen » 19 Apr 2008, 19:04

Thanks for the info Fiss! Very interesting!
Lecia - Have you checked out the Colorectal Health Center?
http://www.crhcenter.com/patients.html
There is one over in your part of the country. Fiss and myself have both been there and I have been very satisfied so far.
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Re: NEW method of treating fissures !!!!

Postby Fissulyna » 20 Apr 2008, 01:02

I am doing worse today : ( , but I am so glad that you are better buddy XOXOOOOOOO
Jen, yes they are good, but not that fantastic I think to deal with such serious problem as Lecia's . I think they are more oriented toward conservative treatments of hemmies - like ligation and stuff. They also are perfect source for conservative treatment of fissures- they offer all kind of creams and Botox too, but they hate to do real surgery , at least that is my experience. My CRS pushed me too hard to wait and try everything else, at the end I had to go to another CRS to do LIS since I was at the end of my wits and also my body suffered too much - I lost 20 pounds in 5 months and my other conditions started to act up - so she should have be more open for surgery in my case. BUT, yes, for ligations and such they are perfect place !!! Nice facilities , modern equipment , disposable scopes , big soft nice exam tables and exams are always laying on the side so one does not feel so humiliated !!!
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Re: NEW method of treating fissures !!!!

Postby happyass » 20 Apr 2008, 06:50

i am not sure if there are different varieties of the metro drug but i am giving it to Bear to help treat reducing toxins released into his bloodstream via the intestines...it think it is the generic name for flagyll actually......
its very strong.
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Re: NEW method of treating fissures !!!!

Postby Fissulyna » 20 Apr 2008, 14:01

Interesting !!! I wonder why it is not dispensed to patients after any CR surgery ??? Anyway - hope that Bear is doing well !
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Re: NEW method of treating fissures !!!!

Postby val » 20 Apr 2008, 14:50

over here they always give antibiotics after dental surgery, its strange its not given after all surgeries.

So sorry you're not well today, Fiss - mine is worse too!
Thats a very interesting article, I wonder if they know about it here in the UK
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Re: NEW method of treating fissures !!!!

Postby dano » 24 Apr 2008, 20:47

that procedure seems to have pretty good results,never heard of the "topical oitment" though....i'd would have tried it if i had to....
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