Controlled digital anal dilatation under total neuromuscular blockade for chronic anal fissure: a justifiable procedure
| Autor: | M E Lucarotti, N A Strugnell, S G Cooke, W H Thomson |
|---|---|
| Rok vydání: | 1999 |
| Předmět: |
Male
medicine.medical_specialty Chronic anal fissure medicine Humans Retrospective Studies Neuromuscular Blockade Anal fissure Wound Healing business.industry Retrospective cohort study Middle Aged Anus medicine.disease Dilatation Surgery medicine.anatomical_structure Impaired control Anal dilatation Chronic Disease Female Fissure in Ano Ultrasonography business Follow-Up Studies |
| Zdroj: | The British journal of surgery. 86(5) |
| ISSN: | 0007-1323 |
| Popis: | BackgroundThere is widespread antipathy to digital dilatation of the anus (DDA) for medically resistant anal fissure. A retrospective study was therefore undertaken to test the validity of the criticism of this technique.MethodsSome 273 patients who underwent DDA for fissure between November 1982 and July 1997 were sent a questionnaire and/or telephoned. Those with impaired control were offered investigation. In addition, routine clinic follow-up data were scrutinized in the 302 available notes of the 307 patients who had undergone DDA for fissure to determine its efficacy.ResultsSome 241 patients (88·3 per cent) were contacted successfully a median of 7·8 years after operation. Follow-up records showed the fissure to have healed in 89·1 per cent of 302 patients. No patient was rendered incontinent. Fifteen patients indicated persistently impaired control in the questionnaire, nine (3·8 per cent) as a result of the DDA and six preceding it. All 23 patients who had experienced either temporary or permanent impairment, whether or not pre-existing, were invited to attend for ultrasonography and manometric measurements, of whom 18 accepted. No sphincteric fragmentation was seen, and resting and squeeze pressures did not differ from normal.ConclusionA single DDA appears to heal 89 per cent of chronic anal fissures. Consequent impairment of control is infrequent and minor if the procedure is performed carefully and with the patient paralysed. |
| Databáze: | OpenAIRE |
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