![]() Gut 44:727–730Īltomare DF, Rinaldi M, Milito G, Arcanà F, Spinelli F, Nardelli N, Scardigno D, Pulvirenti-D’Urso A, Bottini C, Pescatori M, Lovreglio R (2000) Glyceryl trinitrate for chronic anal fissure-healing or headache? Results of a multicenter, randomised, placebo-controlled, double-blind trial. Dis Colon Rectum 42:1000–1006Ĭarapeti EA, Kamm MA, McDonald PJ, Chadwick SJD, Melville D, Phillips RKS (1999) Randomised controlled trial shows that glyceryl trinitrate heals anal fissures, higher doses are not more effective, and there is a high recurrence rate. Kennedy ML, Sowter S, Nguyen H, Lubowski DZ (1999) Glyceryl trinitrate ointment for the treatment of chronic anal fissure. Lund JN, Scholefield JH (1997) A randomised, prospective, double-blind, placebo-controlled trial of glyceryl trinitrate ointment in the treatment of anal fissure. Lock MR, Thompson JP (1977) Fissure-in-ano: the initial management and prognosis. In: Keighley MR, Williams NS (eds) Surgery of the Anus, Rectum and Colon, 2nd edn. Keighley MR, Williams NS (1999) Fissure-in-ano. Morphological evidence that nitric oxide mediates the rectoanal inhibitory reflex. O’Kelly TJ, Davies JR, Brading AF, Mortensen NJMcC (1994) Distribution of nitric oxide synthase containing neurons in the rectal myenteric plexus and anal canal. O’Kelly TJ, Brading AF, Mortensen NJ (1993) Nerve mediated relaxation of the human internal anal sphincter: the role of nitric oxide. Langley JN (1921) The Autonomic Nervous System. Br J Surg 80:1337–1341Ĭook TA, Brading AF, Mortensen NJMcC (1999) Differences in contractile properties of anorectal smooth muscle and the effects of calcium channel blockade. O’Kelly TJ, Brading AF, Mortensen NJMcC (1993) In vitro response of the human anal canal longitudinal muscle layer to cholinergic and adrenergic stimulation: evidence of sphincter specialization. Gibbons CP, Read NW (1986) Anal hypertonia in fissures: cause or effect? Br J Surg 73:443–445 The vascular pathogenesis of anal fissures. Schouten WR, Briel JW, Auwerda JJ (1994) Relationship between anal pressure and anodermal blood flow. Klosterhalfen B, Vogel P, Rixen H, Mittermayer C (1989) Topography of the inferior rectal artery: a possible cause of chronic primary anal fissure. Lund JN, Scholefield JH (1996) Aetiology and treatment of anal fissure. This process is experimental and the keywords may be updated as the learning algorithm improves. These keywords were added by machine and not by the authors. Associated features exclusive to but by no means universally seen in chronic fissure include indurated edges, a sentinel pile and a hypertrophied anal papilla. ![]() ![]() Morphologically, the presence of visible transverse internal anal sphincter fibres at the base of a chronic anal fissure provides a more clear-cut morphological definition. The chronological definition is rather loose, but most surgeons would regard persistence beyond 6 weeks as a reasonable point when an acute fissure, now unlikely to heal with conservative treatment, may be considered chronic. Chronicity is defined both chronologically and morphologically. This review article is restricted to the management of patients with chronic fissure. Most acute fissures heal spontaneously, but a proportion becomes chronic. Anal fissure is a painful tear or split in the distal anal canal.
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