Treatment Algorithm for Chronic Anal Fissure – A Review of Literature and it’s Apply in University Clinical Center Mother Teresa – Skopje

Dzeparoski, Marjan (2014) Treatment Algorithm for Chronic Anal Fissure – A Review of Literature and it’s Apply in University Clinical Center Mother Teresa – Skopje. Macedonian Journal of Medical Sciences, 7 (3). pp. 529-531.

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Abstract

Chronic anal fissure is one of the most frequent anorectal disorders. Symptoms vary but typically
include bright red rectal bleeding, itching and discomfort or pain during and after defecation.
Treatment has undergone a transformation in recent years from surgical to medical, all approaches
sharing the goal of reducing the spasm.
According to the researched treatment guidelines and the experience at the “University Clinical
Center Mother Teresa” (Clinic of Gastroenterohepatology and Clinic of Abdominal Surgery) in
Skopje, Macedonia, we propose the following algorithm for treatment of chronic anal fissure in three
steps: from topical nifedipine + lidocaine cream (first-line) to second course of nifedipine +
lidocaine cream or digital anal dilatation or botulinum toxin type A injection (second-line) to lateral
internal sphincterotomy (third-line).
The proposed treatment algorithm allows patients to start with the least invasive treatment. There is
no doubt that patients are willing to try less invasive modalities with the hope of avoiding surgery,
with its risk of permanent disability. It should be up to the patients to decide which treatment they
prefer. Although chemical sphincterotomy is less successful from lateral internal sphincterotomy,
the algorithm allows feasibility, efficacy and cost-effectiveness, as well as risk reduction for surgical
morbidity.

Item Type:	Article
Impact Factor Value:	0.257
Subjects:	Medical and Health Sciences > Health sciences
Divisions:	Faculty of Medical Science
Depositing User:	Marjan Dzeparoski
Date Deposited:	05 Dec 2023 08:24
Last Modified:	05 Dec 2023 08:24
URI:	https://eprints.ugd.edu.mk/id/eprint/32781

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