analfissure complete introduction, complications, treatment and surgical process

Anal fissure ppt presentation

1. Anal fissures: conservative and surgical treatment options Department of shalya tantra Presenter: Dr Arun Bhati M.S.SCHOLAR

2. Definition An anal fissure is a longitudinal split in the anoderm of the distal anal canal. which extends from the anal verge proximally towards but not beyond the dentate line

3. Common and atypical location of anal fissure

4. Acute anal fissure Chronic anal fissure

5. Aetiology primary Trauma caused by strained evacuation of hard stool. Repeated passage of diarrhoea Anal intercourse Child birth following vaginal delivery secondary Inflammatory bowel disease, tuberculosis, STD, previous anal surgery, carcinoma of anal canal, leukemia

6. pathogenesis 1)Stretching of anal mucosa beyond capacity pull ends spasm tear Decrease healing Chronic fissure 2)Decrease blood flow Increase anal pressure Increase risk of anal fissure

7. Diagnosis Medical history and physical examination

8. symptoms Severe anal pain associated with defecation Bright red bleeding Pruritus Mucus discharge Consitpation

9. Treatment Conservative Non specific medical therapy Diet Bulk laxatives Topical local anesthetic agents Anal hygiene Sitz bath

10. Specific first line therapy Nitric oxide donors usually glyceryl trinitrate cream Diltiazem cream (calcium channel blocker) Tablet. Calcium dobesilate

11. Specific second line therapy Injection Botulinum toxin with a dose varying from 2.5 to 20 units in each site

12. Surgical technique Closed lateral subcutaneous internal sphincterotomy

13. Open internal sphincterotomy

14. Anal advancement flap

15. Laser fissurectomy

16. laser sphincterolysis

17. laser sphincterotomy

18. Complications Infection Bleeding Pain Incontinence Formation of fistula Anal stenosis

19. The Vicious circle of anal fissure

20. Epidemiology There is a deficit in epidemiological studies examining this often encountered disease. 2,35, 000 new cases of anal fissure are reported every year in the US and about 40% of them persist for months and even years Females have higher incidence of 1140 cases per 100,000 as compared to males who have 1070 per 100,000. https://fascrs.org/patients/diseases-and-conditions/a-z/anal-fissure

21. References Bailey and love’s short practice of surgery (27 th edition) Fischer’s Mastery of surgery(7 th edition)