The Experts below are selected from a list of 279 Experts worldwide ranked by ideXlab platform
A L Polglase - One of the best experts on this subject based on the ideXlab platform.
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the longer term results of internal Anal Sphincterotomy for Anal fissure
Australian and New Zealand Journal of Surgery, 1995Co-Authors: V Usatoff, A L PolglaseAbstract:: This study details the results of a retrospective Analysis of 98 patients who underwent lateral subcutaneous internal Sphincterotomy for the treatment of fissure in ano. Data with particular emphasis on patient satisfaction and anorectal control were collected by postal questionnaire. Minimum follow up was 15 months with an average of 41 months. Ninety-seven per cent of patients indicated that they were moderately or very satisfied with the outcome of the procedure and 90% claimed symptomatic improvement with this being sustained in 69%. Eighteen per cent of patients noted ongoing new problems with minor impairment of anorectal control. Despite these symptoms, 90% of this group were also moderately or very pleased with the outcome and 72% had resolution of their symptoms which was sustained in more than two-thirds of cases. It is concluded that lateral subcutaneous internal Sphincterotomy is well tolerated and the majority of patients are more than moderately pleased with the outcome. There was however a significant incidence of minor impairment in anorectal control but this did not detract from the perceived success of the procedure.
Yikhong Ho - One of the best experts on this subject based on the ideXlab platform.
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randomized clinical trial comparing oral nifedipine with lateral Anal Sphincterotomy and tailored Sphincterotomy in the treatment of chronic Anal fissure
British Journal of Surgery, 2005Co-Authors: K S Ho, Yikhong HoAbstract:Background: The conventional treatment of chronic Anal fissure is lateral Sphincterotomy (LAS). The alternative options of tailored Sphincterotomy (TS) and chemical Sphincterotomy using medication such as nifedipine have recently become available. Methods: A prospective randomized trial was conducted to compare LAS with TS and oral nifedipine. The main endpoints were fissure healing, symptom relief, recurrence and continence. Results: One hundred and thirty-two patients were treated and followed up for 4 months. LAS was significantly more effective than TS in providing pain relief (P = 0·004) and better patient satisfaction (P = 0·020) at 4 weeks. Surgery (LAS and TS) was associated with significantly better fissure healing rates (both P < 0·001 at 16 weeks) and less recurrence (both P = 0·003) than nifedipine. There were substantial problems with compliance in the nifedipine group (17 of 41 patients), related to side-effects and slow healing. There were no differences in continence between the three treatment groups. Conclusion: LAS was most effective in providing pain relief and allowing rapid fissure healing, with minimal recurrence and no increased risk of incontinence, in patients with good Anal sphincter function.
Mario Pescatori - One of the best experts on this subject based on the ideXlab platform.
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glyceryl trinitrate for chronic Anal fissure healing or headache results of a multicenter randomized placebo controlled double blind trial
Diseases of The Colon & Rectum, 2000Co-Authors: Donato Francesco Altomare, F Arcana, Fernando Spinelli, Donato Scardigno, Antonio Pulvirentidurso, C Bottini, Giovanni Milito, Nicola Nardelli, M. Rinaldi, Mario PescatoriAbstract:PURPOSE: Internal Anal Sphincterotomy for treating chronic Anal fissure can irreversibly damage Anal continence. Reversible chemical Sphincterotomy may be achieved by Anal application of glyceryl trinitrate ointment (nitric oxide donor), which has been reported to heal the majority of patients with Anal fissure by inducing sphincter relaxation and improving anodermal blood flow. This trial aimed to further clarify the role of glyceryl trinitrate in the treatment of chronic Anal fissure. METHODS: A total of 132 consecutive patients from nine centers were randomly assigned to receive 0.2 percent glyceryl trinitrate ointment or placebo twice daily for at least four weeks. The severity of pain and maximum Anal resting pressure were measured before and after one week of treatment. Anodermal blood flow was measured before and after application of glyceryl trinitrate or placebo in ten patients. RESULTS: The study was completed by 119 patients (59 glyceryl trinitrate and 60 placebo), matched for gender, age, duration of symptoms, duration of treatment, site of fissure, previous attempts to treat, pain score, and maximum Anal resting pressure. Twenty-nine patients (49.2 percent) healed after glyceryl trinitrate and 31 patients (51.7 percent) healed after placebo (P= not significant). Pain score fell significantly in both groups, in addition to maximum Anal resting pressure. Anodermal blood flow improved significantly in seven patients receiving glyceryl trinitrate, but not in the three receiving placebo. Twenty-three patients (33.8 percent) experienced headache and 4 (5.9 percent), orthostatic hypotension after glyceryl trinitrate. CONCLUSION: This trial fails to demonstrate any superiority of topical 0.2 percent glyceryl trinitrate treatmentvs. a placebo, although the effects of glyceryl trinitrate on anodermal blood flow and sphincter pressure are confirmed. This finding, together with the high incidence of side-effects, should discourage the use of this treatment as a substitute for surgery in chronic Anal fissure.
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Glyceryl trinitrate for chronic Anal fissure—Healing or headache?
Diseases of the Colon & Rectum, 2000Co-Authors: Donato Francesco Altomare, F Arcana, Fernando Spinelli, Donato Scardigno, C Bottini, Giovanni Milito, Nicola Nardelli, M. Rinaldi, Antonio Pulvirenti-d'urso, Mario PescatoriAbstract:PURPOSE: Internal Anal Sphincterotomy for treating chronic Anal fissure can irreversibly damage Anal continence. Reversible chemical Sphincterotomy may be achieved by Anal application of glyceryl trinitrate ointment (nitric oxide donor), which has been reported to heal the majority of patients with Anal fissure by inducing sphincter relaxation and improving anodermal blood flow. This trial aimed to further clarify the role of glyceryl trinitrate in the treatment of chronic Anal fissure. METHODS: A total of 132 consecutive patients from nine centers were randomly assigned to receive 0.2 percent glyceryl trinitrate ointment or placebo twice daily for at least four weeks. The severity of pain and maximum Anal resting pressure were measured before and after one week of treatment. Anodermal blood flow was measured before and after application of glyceryl trinitrate or placebo in ten patients. RESULTS: The study was completed by 119 patients (59 glyceryl trinitrate and 60 placebo), matched for gender, age, duration of symptoms, duration of treatment, site of fissure, previous attempts to treat, pain score, and maximum Anal resting pressure. Twenty-nine patients (49.2 percent) healed after glyceryl trinitrate and 31 patients (51.7 percent) healed after placebo ( P = not significant). Pain score fell significantly in both groups, in addition to maximum Anal resting pressure. Anodermal blood flow improved significantly in seven patients receiving glyceryl trinitrate, but not in the three receiving placebo. Twenty-three patients (33.8 percent) experienced headache and 4 (5.9 percent), orthostatic hypotension after glyceryl trinitrate. CONCLUSION: This trial fails to demonstrate any superiority of topical 0.2 percent glyceryl trinitrate treatment vs. a placebo, although the effects of glyceryl trinitrate on anodermal blood flow and sphincter pressure are confirmed. This finding, together with the high incidence of side-effects, should discourage the use of this treatment as a substitute for surgery in chronic Anal fissure.
V Usatoff - One of the best experts on this subject based on the ideXlab platform.
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the longer term results of internal Anal Sphincterotomy for Anal fissure
Australian and New Zealand Journal of Surgery, 1995Co-Authors: V Usatoff, A L PolglaseAbstract:: This study details the results of a retrospective Analysis of 98 patients who underwent lateral subcutaneous internal Sphincterotomy for the treatment of fissure in ano. Data with particular emphasis on patient satisfaction and anorectal control were collected by postal questionnaire. Minimum follow up was 15 months with an average of 41 months. Ninety-seven per cent of patients indicated that they were moderately or very satisfied with the outcome of the procedure and 90% claimed symptomatic improvement with this being sustained in 69%. Eighteen per cent of patients noted ongoing new problems with minor impairment of anorectal control. Despite these symptoms, 90% of this group were also moderately or very pleased with the outcome and 72% had resolution of their symptoms which was sustained in more than two-thirds of cases. It is concluded that lateral subcutaneous internal Sphincterotomy is well tolerated and the majority of patients are more than moderately pleased with the outcome. There was however a significant incidence of minor impairment in anorectal control but this did not detract from the perceived success of the procedure.
K S Ho - One of the best experts on this subject based on the ideXlab platform.
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randomized clinical trial comparing oral nifedipine with lateral Anal Sphincterotomy and tailored Sphincterotomy in the treatment of chronic Anal fissure
British Journal of Surgery, 2005Co-Authors: K S Ho, Yikhong HoAbstract:Background: The conventional treatment of chronic Anal fissure is lateral Sphincterotomy (LAS). The alternative options of tailored Sphincterotomy (TS) and chemical Sphincterotomy using medication such as nifedipine have recently become available. Methods: A prospective randomized trial was conducted to compare LAS with TS and oral nifedipine. The main endpoints were fissure healing, symptom relief, recurrence and continence. Results: One hundred and thirty-two patients were treated and followed up for 4 months. LAS was significantly more effective than TS in providing pain relief (P = 0·004) and better patient satisfaction (P = 0·020) at 4 weeks. Surgery (LAS and TS) was associated with significantly better fissure healing rates (both P < 0·001 at 16 weeks) and less recurrence (both P = 0·003) than nifedipine. There were substantial problems with compliance in the nifedipine group (17 of 41 patients), related to side-effects and slow healing. There were no differences in continence between the three treatment groups. Conclusion: LAS was most effective in providing pain relief and allowing rapid fissure healing, with minimal recurrence and no increased risk of incontinence, in patients with good Anal sphincter function.
