Treatment of Anal Fissure

How I treat anal fissure

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Treatment of Anal Fissure

Postby FissureDoctor » 04 Jan 2018, 18:12

Hello,
I am a colon and rectal surgeon from Long Island, NY. I just discovered this forum, and have read some interesting posts. I have a special interest in the treatment of anal fissure. Please read about how I approach this problem at http://www.colonandrectalsurgeons.com/anal-fissure/. I hope you will find this information useful.
Dr. Leiboff
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Re: Treatment of Anal Fissure

Postby patience_and_healing » 04 Jan 2018, 20:18

Wow, I'm surprised to see a doctor posting here. There have been a couple of members on this forum who were treated by you. I assume they are still doing well now.
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Re: Treatment of Anal Fissure

Postby FissureDoctor » 04 Jan 2018, 23:35

I hope they are doing well. Recurrence of fissure is always possible. I prefer Standardiazed Anal Dilatation over lateral internal sphincterotomy because I believe it to be a safer choice, not because I believe it has a higher success rate. I welcome all feedback, positive or negative. It would be nice to conduct a randomized prospective trial to compare the two approaches
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Re: Treatment of Anal Fissure

Postby patience_and_healing » 05 Jan 2018, 01:40

At one desperate point I did consider traveling to the east coast to see you but two things stopped me: 1) If SAD is a viable option, why isn't it practiced by more than one doctor in the country? 2) I couldn't find any papers published by you comparing the two techniques, not even a paper based solely on the results of SAD. There was also a lack of any kind of informative articles besides your website.

I couldn't consider undergoing a procedure that the majority of doctors have no knowledge of and who probably couldn't help me if something were to go wrong. I hope you don't take this in a negative sense, but this is my point of view. I'm sure many patients have benefitted from your treatment, but it just didn't seem like the right choice for me.
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Re: Treatment of Anal Fissure

Postby FissureDoctor » 05 Jan 2018, 05:42

Yes, there is a dearth of literature on the subject, but there is some:

Sohn N, Eisenberg MM, Weinstein MA, Lugo RN, Adler J. Precise anorectal sphincter dilatation: its role in the therapy of anal fissures. Dis Colon Rectum 1992;35:322-7
Perez-Miranda M, Robledo P, Alcalde M, Gomez-Cedenilla A, Mate Jimenez J. Endoscopic anal dilatation for fissure-in-ano: a new outpatient treatment modality. Rev Esp Enferm Dig 1996 Apr;88(4):265-72
Sohn N, Weinstein MA. Seminars in Colon & Rectal Surgery 1997 March; 8(1):17-23
Walfisch S, Silberstein E. Balloon anal dilatation for anal fissure. Tech Coloproctol 1998;2:73-75
Boschetto S, Giovannone M, Tosoni M, Barberani F. Hydropneumatic anal dilation in conservative treatment of chronic anal fissure: clinical outcomes and randomized comparison with topical nitroglycerin. Tech Coloproctol 2004 August;8(2):89-92
Renzi A, Brusciano L, Pescatori M, Izzo D, Napolitano V, Rossetti G, del Genio G, del Genio A. Pneumatic balloon dilatation for chronic anal fissure: a prospective, clinical, endosonographic, and manometric study. Dis Colon Rectum 2005 Jan;48(1):121-6
Renzi A, Izzo D, Di Sarno G, Talento P, Torelli F, Izzo G, Di Martino N. Clinical, manometric, and ultrasonographic results of pneumatic balloon dilatation vs. lateral internal sphincterotomy for chronic anal fissure: a prospective, randomized, controlled trial. Dis Colon Rectum 2008 Jan;51:121-7
Yucel T, Gonullu D, Oncu M, Koksoy FN, Ozkan SG, Aycan O. Comparison of controlled-intermittent anal dilatation and lateral internal sphincterotomy in the treatment of chronic anal fissures: a prospective, randomized study. Int J Surg 2009 Jun;7(3):228-31
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Re: Treatment of Anal Fissure

Postby patience_and_healing » 05 Jan 2018, 12:06

Thanks for the names of the papers. I've actually read the summaries of most of them already. I was referring initially to your medical practice in particular. It would be great if you published your results and made the technique better known in the country.

Here is the link to the forum diary of one of your patients /my-standardized-anal-dilatation-this-morning-t4104.html.
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Re: Treatment of Anal Fissure

Postby FissureDoctor » 05 Jan 2018, 23:18

Thank you for pointing out these posts. I keep records in the form of questionaires on all my fissure patients and hope one day to publish. But as I point out on my website, I have been doing this since 2008 and results and feedback have been quite good, so I continue to perform Standardized Anal Dilatation regularly. I use the terminology “Standardized Anal Dilatation” because it is/was preferred by Dr. Sohn. It distinguishes his method from manual anal dilatation that is not controlled or precise, which is more likely to cause incontinence, and which I don’t recommend. Note that Dr. Sohn learned over time that it is much easier and just as effective to use rigid dilators rather than balloons. The method is actually quite simple. To help other doctors adopt this method I have made Sohn’s Dilators and a description of the method, available: see
http://www.toolsforsurgery.com/SOD/.
Thanks.
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Re: Treatment of Anal Fissure

Postby patience_and_healing » 07 Jan 2018, 01:21

I read through the link and it was quite informative. I do wonder though whether the external sphincter would be damaged by the dilator. It's the one thing that helps to maintain continence if the internal muscle is too weak. Also how does dilation help heal fissures with low pressure? I thought the whole point of dilation was to lower pressure and bring blood flow to the fissure for healing. Thanks for answering my questions!
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Re: Treatment of Anal Fissure

Postby FissureDoctor » 07 Jan 2018, 04:18

I follow the recommendations of Dr. Sohn, see http://www.toolsforsurgery.com/download ... or-Use.pdf, and have not seen any permanent or significant incontinence. It is not unusual to stretch the sphincter to this degree during the course of other anorectal surgical procedures, for example, TAMIS (transanal minimally invasive surgery). I use this technique only if I think the anal sphincter pressure is high, which is true for most fissures. Improving blood flow is one theory of how these measures work. But both dilatation and cutting the sphincter have been known as effective treatments for anal fissure since the mid-1800s.
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Re: Treatment of Anal Fissure

Postby patience_and_healing » 08 Jan 2018, 21:23

That's interesting to know. Thanks
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