statistics on fissures

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statistics on fissures

Postby normajeanchariot » 25 Sep 2016, 10:21

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4079811/

"Six hundred and twelve patients (303 women: mean age, 39 years; range, 16-86 years) were treated for chronic anal fissure between 1998 and 2008. Topical diltiazem 2% was initially prescribed for 8 weeks. The fissure did not heal in 141 patients. These patients (61 women: mean age, 30 years; range, 15-86 years) were treated with 100 IU botulinum A toxin (Botox) injection combined with a fissurectomy under general anaesthesia. Thirty eight patients suffered a recurrence of their fissure within two years. Thirty-four healed with further medical or sphincter conserving surgical therapy while four required a lateral internal sphincterotomy."

....So if I'm reading correctly from this particular study - from 612 chronic anal fissure sufferers, 77% healed from diltiazem (applied for 8 weeks). From the 23% that didn't heal, 73% were healed (for at least 2 years) after a botox injection and fissurectomy. From the 27% still not healed, 89% were healed after further medical or sphincter conserving surgical therapy (whatever that was). 0.006% of people didn't heal from all that and 'required' an lis.

I'm really not sure on the value of botox (I'm trying to decide between botox and lis). It seems to have good success rates but then I'll read about someone who had botox and had nerve damage or something from the botox. On the other hand, sometimes incontinence and reported as being quite high after an lis (like 20%? i hav no source) and others claim its really low (like 3%) or something.

LIS:
- "persistent incontinence to gas occurred in 30 percent" http://www.ncbi.nlm.nih.gov/pubmed/15906136
- 10.2% were left incontinent http://www.ncbi.nlm.nih.gov/pubmed/16007364
- 8% incontinent to stool (refer next two paragraphs for source).

I'm also quite sceptical about surgeon's data. From the book titled: "Reconstructive Surgery of the Rectum, Anus and Perineum" (see https://books.google.com.au/books?id=ec ... ce&f=false):

It mentions a theory that surgeons construct their surveys in a way that reduces the number of people reporting incontinence. It states "A review of patient notes after LIS reported gas incontinence in only 4.4% of patients and stool incontinence in 2.8%, whereas an annonymous questionnaire completed by the same patients revealed a much higher rate of gas incontinence (31.5%) and stool incontinence (28.7%)". HOWEVER, it then goes on to say "symptoms persisted at 3 months postoperatively in 30% for gas incontinence and 8% for stool incontinence". So I'm assuming this means that 3 months after the surgery, 8% were suffering from stool incontinence (still much higher than the 2.8% they reported).

Anyways, this post may become a place to copy and paste key stats on fissures to construct a true representation of things. One thing about this forum is that it will generally attract those currently suffering from a fissure. Most people who are healed and have been healed for several years probably won't visit this page and this can severely skew our perception of success rates, etc.

So if you feel like doing some research, feel free to paste it here.
Last edited by normajeanchariot on 25 Sep 2016, 21:48, edited 1 time in total.
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Re: statistics on fissures

Postby chachacha » 25 Sep 2016, 10:47

Those having botox though, according to the study, also had a fissurectomy. A fissurectomy is a surgical procedure no less invasive than LIS, and apparently much less effective over the long-term.

Also, if you can still edit your post, you have mistakenly come up with 33% after deducting 77 from 100. 77% and 23% = 100%, not 77% and 33% (110%).
Fissure since about 2007
Fissure diagnosed in 2011
Diltiazem for two years - didn't work well
LIS January, 2015
Hemorrhoidectomy December, 2017
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Re: statistics on fissures

Postby Buttpalsteven » 25 Sep 2016, 10:58

Hi there, lots of others have posted studies on this forum...

nhs-0-5-incontinence-statistics-after-lis-surgery-t4456.html

topic6112.html

I think the 2.8% that you are reading is reflected upon long-term incontinence, but even that number includes a range of incontinence. I imagine fecal incontinence is extremely extremely rare, I have tried finding a case where someone suffered severe incontinence issues but havn't found any online.

Having some incontinence following the surgery is not uncommon but it should be temporary and go away as you heal. The percentages you reported are self-report - meaning the patient decided if they were incontinent or not rather than their physician. For example, I had LIS done a few weeks ago. I had an accidental fart or two so that could classify me as "gas incontinent".. but I'm sure we've all had a fart or two slip out in our lives :p so you really have to take self-report medical questionnaires with a grain of salt as patients don't necessarily understand the questions being asked of them.

It is also important to keep in mind who is conducting the surgery. The chance of incontinence is much much lower if you have the procedure done by a Colorectal Surgeon as compared to a General Practitioner (as a result of experience and education on the LIS procedure).

The biggest piece of advice I can give is to ask your surgeon about his or her success rate with the procedure. If a few of their patients have had incontinence issues, you might want to consider another physician.The procedure is overall pretty safe. However, they are obligated to discuss the risks as it CAN happen. I wouldn't be concerned about being one of the freak accident cases!! You also have to keep in mind other factors such as demographics (age) and procedure (many people who have LIS have other procedures done at the same time) that might influence your chance of incontinence.
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Re: statistics on fissures

Postby normajeanchariot » 28 Sep 2016, 06:55

Another study:
"Patients in the sphincterotomy group (n = 50) underwent lateral internal anal sphincterotomy" "Sphincterotomy was associated with a significantly higher complication rate (8 cases of anal incontinence none in the botulinum toxin group; P < 0.001)" Yeah that's 8/50 were left incontinent.. am I reading that right? That's 16%!

Source: https://www.ncbi.nlm.nih.gov/pubmed/12576897
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Re: statistics on fissures

Postby normajeanchariot » 29 Sep 2016, 03:35

"Background and objective: The function of the internal sphincter is disturbed in patients with chronic anal fissure due to persistent hypertonia and it may lead to a certain degree of incontinence. Our aim is to assess the results of lateral internal sphincterotomy and to identify any degree of incontinence related to the disease. Methods: This prospective study included a review of all patients operated upon by the authors who performed division of the internal sphincter at or below the upper limit of the fissure. A questionnaire was completed by each patient before surgery and then after surgery with regard to any degree of incontinence such as soiling of underclothes, control of flatus and accidental bowel motion. Results: 126 patients with chronic anal fissure were studied. The male to female ratio was 0.8:1. Minor degrees of incontinence were present prior to surgery in 35 patients (28%) and in 31 (25%) patients after surgery, the majority of them were incontinent before surgery. Conclusion: Based on the results of this study, minor degrees of incontinence could be a symptom of chronic anal fissure and not the sequelae of lateral internal sphincterotomy"

Source: http://www.thesurgeon.net/article/S1479-666X(04)80005-2/abstract

Interesting stuff.
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Re: statistics on fissures

Postby Buttpalsteven » 29 Sep 2016, 22:09

In the study where you read "8" were incontinent, there are some things to keep in mind. First of all, at the 2 month mark 49/50 patients found success or "overall healing". It did say 8 cases of incontinent complications but did not discuss if the complications lasted longer than one checkup in the abstract (for example, they may have been incontinent at day 7, but healed/corrected by day 28.. it is still written as a complication of incontinence). I tried to get access to the article but couldn't get it. It's important to denote gas incontinence from fecal incontinence too. Not being able to control passing gas for a few days following the procedure is nothing to be concerned about!

50 is also a very small sample size.
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