Management of chronic anal fissure: results of a national survey among gastrointestinal surgeons in the Netherlands.

Autor: van Reijn-Baggen DA; Department of Surgery, Proctos Clinic, Bilthoven, The Netherlands. davr@me.com.; Department of Urology, Leiden University Medical Center, Leiden, The Netherlands. davr@me.com., Dekker L; Department of Surgery, Proctos Clinic, Bilthoven, The Netherlands.; Department of Surgery, Amsterdam University Medical Center, Location AMC, Amsterdam, The Netherlands., Elzevier HW; Department of Urology, Leiden University Medical Center, Leiden, The Netherlands.; Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands., Pelger RCM; Department of Urology, Leiden University Medical Center, Leiden, The Netherlands., Han-Geurts IJM; Department of Surgery, Proctos Clinic, Bilthoven, The Netherlands.
Jazyk: angličtina
Zdroj: International journal of colorectal disease [Int J Colorectal Dis] 2022 Apr; Vol. 37 (4), pp. 973-978. Date of Electronic Publication: 2022 Feb 22.
DOI: 10.1007/s00384-022-04115-9
Abstrakt: Background: Chronic anal fissure (CAF) is a common, bothersome condition frequently accompanied by pelvic floor complaints. Despite current guidelines, optimal management is challenging. The aim of this study is to evaluate current management of CAF among gastrointestinal surgeons in the Netherlands.
Methods: Dutch gastrointestinal surgeons and residents were sent a survey invitation by email, which was available online between June 2021 and September 2021. The questionnaire consisted of 21 questions concerning work experience, physical examination, diagnostic and surgical techniques, and follow-up.
Results: Overall, 106 (33%) respondents completed the survey. Most respondents (59%) had at least 10 years of experience in treating CAF. Only 23% always addressed pelvic floor complaints. Fifty-one percent performed digital rectal examination and 22% always, or almost always, examined the pelvic floor muscles. Most respondents started treatment with fibers and/or laxatives and ointment (96%). Diltiazem was in 90% the preferred ointment. Twenty-two percent referred patients for pelvic floor physical therapy. Botulinum toxin was in 54% performed under general or spinal anesthesia or sedation. The surgical procedure of choice was fissurectomy (71%) followed by lateral internal sphincterotomy (27%). Fissurectomy was in 51% always combined with botulinum toxin. Fifty-seven percent of the respondents preferred a physical follow-up appointment.
Conclusion: Guideline recommendations are largely followed in the Netherlands, starting with conservative measures followed by surgical procedures. Surgeons do not consistently assess pelvic floor complaints, nor do they routinely examine the pelvic floor muscles. Awareness of pelvic floor dysfunctions is important to refer patients for pelvic floor physical therapy.
(© 2022. The Author(s).)
Databáze: MEDLINE
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