Статті в журналах: "Standard sphincterotomy"

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Liguory, Claude, Jean Francois Lefebvre, Didier Bonnel, and Gary C. Vitale. "Cutting the Difficult Papilla: Ancillary Techniques in the Performance of Endoscopic Sphincterotomy." Canadian Journal of Gastroenterology 4, no. 9 (1990): 564–67. http://dx.doi.org/10.1155/1990/254189.

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Of 1040 endoscopic sphincterotomies performed over a five year period, standard papillotomy was possible in 874 (84%). In 166 cases (16%) a difficult papilla was encountered requiring nonstandard techniques of precutting, transpapillary guided endoscopic sphincterotomy, transhepatic guided endoscopic sphincterotomy and percutaneous transhepatic sphincterotomy. The technique first attempted in these 166 cases was successfully completed in 154 (93%). Among the 135 cases with intradiverticular papillas, successful papillotomy was achieved in 125 (92.7%). Early complications of standard endoscopic sphin-.lerotomy included bleeding, perforation, pancreatitis and cholangitis, comprising 4.3% of the 1040 sphincterocomies. There were five deaths (mortality rate 0.5%) and laparotomy was required in six patients (0.6%). Conditions contributing to complications included an intradiverticular papilla and precutting. Evaluation of endoscopic sphincterotomy by transpapillary or transhepatic routes guided by guidewire or drain placement revealed complication rates of 6.6 and 10.6%, respectively. Of the patients with histories of gastric resection and Billroth II anastomoses, standard sphincterotomy was possible in 15 (55.5%); in two cases the papilla was unapproachable endoscopically, requiring use of percutaneous transhepatic sphincterotomy. The percutaneous transhepatic sphincterotomy without endoscopic control is felt to be a higher risk procedure and should be reserved for rare indications. Appropriate use of these techniques should allow performance of endoscopic sphincterotomy in almost all clinical settings.

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Coelho-Prabhu, N., I. Dzeletovic, and T. Baron. "Outcome of access sphincterotomy using a needle knife converted from a standard biliary sphincterotome." Endoscopy 44, no. 07 (June 21, 2012): 711–14. http://dx.doi.org/10.1055/s-0032-1309773.

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Zaher, Tarik. "Video Case: Sphincterotomy after Small Pre-cut of the Major Duodenal Papilla using Standard Sphincterotome." Afro-Egyptian Journal of Infectious and Endemic Diseases 3, no. 4 (December 12, 2013): 154. http://dx.doi.org/10.21608/aeji.2013.18259.

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Kad, Anil M., Murtaza Akhtar, Rajiv Sonarkar, Divish Saxena, Kanav Kumar, and Siddharth Keswani. "A comparison of segmental internal sphincterotomy versus lateral internal sphincterotomy in management of chronic fissure in ano." International Surgery Journal 4, no. 9 (August 24, 2017): 3044. http://dx.doi.org/10.18203/2349-2902.isj20173884.

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Background: Fissure in ano is one of the commonest benign and painful proctologic condition encountered in surgical practice treated by conservative line of management. Lateral sphincterotomy is the ideal treatment option for chronic refractory fissure in ano. A newer modality segmental internal sphincterotomy shows good promise in terms of early resolution of symptoms, fissure healing and prevention of anal incontinence involving division of the internal sphincter at two different levels.Methods: In comparative nonrandomized trial patients with chronic fissure in ano satisfying the inclusion and exclusion criteria were allocated to lateral sphincterotomy and segmental internal sphincterotomy groups. The outcome factors were perianal sepsis, pain relief using VAS as assessed on passing the first motion, duration of healing of fissure, assessment of incontinence using Wexner’s continence score on 30th post-operative day.Results: A total of 54 cases were enrolled, of them 31 patients underwent lateral internal sphincterotomy and 23 underwent segmental internal sphincterotomy with the mean age of patient was 34.76 years and a male to female ratio of 1.07:1. The pain score (VAS) on passing stool for the first time postoperatively was 4.5 with lateral sphincterotomy and 3.91 with segmental internal sphincterotomy which was statistically significant (P value < 0.010). The duration of postoperative healing was observed to be 27.94 days and 28.09 days in lateral sphincterotomy and segmental internal sphincterotomy group respectively. The post-operative anal incontinence was evaluated by using Wexner’s continence grading after one month which was not statistically significant between two groups.Conclusions: Segmental internal sphincterotomy could be a good surgical modality with its healing effect on fissure in ano and post-operative complications which are similar to standard lateral internal sphincterotomy.

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Zngana, Abdulqadir, and Bawan Hiwa. "A comparative study between lateral internal anal sphincterotomy and botulinum toxin injection in the treatment of chronic anal fissure." Zanco Journal of Medical Sciences 25, no. 2 (August 11, 2021): 513–19. http://dx.doi.org/10.15218/zjms.2021.014.

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Background and objective: The gold standard for the treatment of chronic anal fissure is lateral internal sphincterotomy. Botulinum toxin injection provides temporary alleviation of sphincter spasm and allows the fissure to heal. This study aimed to compare the outcomes of lateral internal sphincterotomy and botulinum toxin injection treatments in patients with uncomplicated chronic anal fissure. Methods: A prospective comparative study was carried out at the surgical unit of Erbil teaching hospital, Erbil, Kurdistan Region of Iraq, from January 2017 to February 2018. Fifty-five patients were enrolled in this study. Five patients were excluded, and the remaining 50 patients were equally divided into two groups. Group A was managed with lateral internal sphincterotomy and group B with botulinum toxin. Postoperative pain relief, bleeding, fissure healing, incontinence, and relapse after six weeks and three months of follow-up were compared. Results: One month after treatment, 12% of the lateral internal sphincterotomy group had bleeding, while none of the botulinum toxin group (P = 0.234). Two patients (8%) of the lateral internal sphincterotomy group had pain while one (4%) of the botulinum toxin group (P >0.999).Three months after treatment, 4% of the lateral internal sphincterotomy group had bleeding, while none of the botulinum toxin group (P >0.999). None of the lateral internal sphincterotomy group had pain while one (4%) of the botulinum toxin group (P >0.999). Regarding healing, 96% of the lateral internal sphincterotomy group healed, while 92% in the botulinum toxin group (P >0.999). Conclusion: The outcome of lateral internal sphincterotomy and botulinum toxin were nearly the same, but lateral internal sphincterotomy required hospitalization, period off work, and risk of anesthesia. These risks were absent in botulinum toxin injection. Keywords: Chronic anal fissure; Lateral internal sphincterotomy; Botulinum toxin; Complications.

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Maple, John T., Lilah Mansour, Tarek Ammar, Michael Ansstas, Gregory A. Coté, and Riad R. Azar. "Physician-Controlled Wire-Guided Cannulation of the Minor Papilla." Diagnostic and Therapeutic Endoscopy 2010 (August 11, 2010): 1–4. http://dx.doi.org/10.1155/2010/629308.

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Background. Minor papilla (MiP) cannulation is frequently performed using specialized small-caliber accessories. Outcomes data for MiP cannulation with standard-sized accessories are lacking. Methods. This is a case series describing MiP cannulation outcomes in consecutive patients treated by two endoscopists between July 2005 and November 2008 at two tertiary referral centers. MiP cannulation was attempted using a 4.4 Fr tip sphincterotome loaded with a , 260 cm hydrophilic-tip guidewire, using a wire-guided technique under physician control. Results. 25 patients were identified (14 women, mean age 45). Procedure indications included recurrent acute pancreatitis in 16 patients (64%) and chronic pancreatitis in 2 (8%), among other indications. MiP cannulation was successful in 24 patients (96%). Sphincterotomy followed by pancreatic stent placement was performed in 21 patients (84%). Mild post-ERCP pancreatitis occurred in 3 patients (12%). Conclusion. Physician-controlled wire-guided MiP cannulation using a 4.4 Fr sphincterotome and guidewire is an effective and safe technique.

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Kim, Kwang Min, and Jong Kyun Lee. "Is Limited Endoscopic Sphincterotomy with Large Balloon Dilation Safer and More Effective than Standard Endoscopic Sphincterotomy?" Korean Journal of Gastroenterology 62, no. 6 (2013): 382. http://dx.doi.org/10.4166/kjg.2013.62.6.382.

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Yusifzade, K. R. "Rationale for effectiveness of a new method of radial sphincterotomy during obstruction of extrahepatic bile ducts." Kazan medical journal 95, no. 6 (December 15, 2014): 816–21. http://dx.doi.org/10.17816/kmj1987.

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Aim. Determination of the effectiveness of the improved method of sphincterotomy in choledocholithiasis, called radial sphincterotomy. Methods. Analyzed were results of 38 operations performed by endoscopic retrograde cholangiopancreatography in patients with a diagnosis of choledocholithiasis. In the first group (23 patients) performed a standard sphincterotomy, in the second group - radial sphincterotomy. 21 patients of the first group had gallstones up to 20 mm, 2 patients - more than 20 mm; in 6 patients (out of 15) of a second group gallstones sizes exceeded 20 mm, the other patients had stones sizes 15-20 mm. Results. The technique developed radial sphincterotomy allows multiple incisions towards 11, 12 and 13 hour clock directions. Thus, the main incision can be made to the transverse folds, and other radial incisions should be carried out below it, not going beyond the proposed location of the intramural common bile duct. Anatomical and mathematical justifications of the method of radial sphincterotomy were presented. Depending on the cut and shape of papillae, the severity of the upper transverse folds defining a safe distance from the hole until it papillae, performed lateral radial incisions, thereby achieving an increase of sphincterotomy cut altogether. Neither group registered death. In 2 (8.7%) patients of the first group bleeding occurred during the procedure, after the operation pancreatitis has developed in 1 (4.3%) patients in first group and in 1 (6.7%) patients in the second group. Conclusion. The proposed technique of radial sphincterotomy is a safe way to increase the area of dissected papillae to provide high efficiency for removal of large gallstones.

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Zim, Hasnat Zaman, Debashish Bar, Ashok Kumar Sarker, and Salma Sultana. "Early Outcome of Open versus Closed Lateral Internal Anal Sphincterotomy in the Treatment of Chronic Anal Fissure." Journal of Surgical Sciences 22, no. 1 (March 22, 2020): 52–57. http://dx.doi.org/10.3329/jss.v22i1.44027.

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Background: Chronic anal fissure is a benign disorder that is associated with considerable discomfort. Surgical treatment in the form of lateral internal sphincterotomy has long been regarded as the gold standard of treatment. Two methods of sphincterotomy are currently practiced: open or closed technique. Objective: The objective of this study was to compare the early outcome of closed versus open lateral internal anal sphincterotomy for the treatment of chronic anal fissure, based on the assessment of post-operative pain and complications. Methods: A comparative study was conducted at the department of surgery in Dhaka Medical College & Hospital, over a period of 6 months from April 2015 to September 2015. A total of 80 patients were purposefully included in this study and were equally divided into two groups; Group A included 40 patients undergone closed lateral internal anal sphincterotomy and Group B included 40 patients undergone open lateral internal anal sphincterotomy. Patients were followed up postoperatively for 6 weeks to assess any complications. The outcomes were compared between the groups using the Chi-square (x2) test and Student's "t" test. Results: Delayed postoperative healing was found in 7.5% patients of the open lateral internal anal sphincterotomy group. The mean pain score and duration of hospital stay were lower in closed lateral internal anal sphincterotomy group. Conclusion: Closed lateral internal sphincterotomy is preferred to open technique in the treatment of chronic anal fissure, as it is effective, safe, less expensive, and is associated with low complication rate. Journal of Surgical Sciences (2018) Vol. 22 (1): 52-57

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Nawaz, Allah, Khalid Mahmood, Nazim Hayat, Ahmad Hassan Khan, Asad Rizwan Rana, and Raza Farooq. "A comparative study of the results of the lateral internal anal sphincterotomy vs manual dilatation of anus for chronic anal fissure." Professional Medical Journal 27, no. 11 (November 10, 2020): 2295–99. http://dx.doi.org/10.29309/tpmj/2020.27.11.5746.

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Objectives: To compare the results of surgical treatment of chronic anal fissure after lateral internal sphincterotomy with manual dilatation of anus. Study Design: Randomized Controlled Prospective study. Setting: Department of Surgery District Teaching Hospital Sargodha, Pakistan. Period: April 2018 to Feb 2019. Material & Methods: Patients were divided into two groups by lottery method. The procedures were performed using standard protocols after obtaining written informed consent. 50 patients underwent lateral internal anal sphincterotomy (Group 1) and 50 patients manual dilatation of anus (Group 2). Patients having atypical anal fissures associated with other diseases were excluded from this study. We assessed both groups for persistence of symptoms, complications and better satisfaction in terms of surgical techniques. Results: All patients became symptoms free within 07-14 days of surgery. Urinary retention was noted in 2(4%) patients in lateral internal sphincterotomy and 2(4%) in manual dilatation of anus. Temporary flatus Incontinence was noted in 2(4%) patient of lateral internal sphincterotomy and 2(4%) in manual dilatation of anus. Faecal soiling was observed in 1(2%) patient of lateral internal sphincterotomy. No recurrence, anal stenosis, hemorrhage, infection of wound, pain and bleeding associated with defecation was seen in both groups. Conclusion: Both lateral internal sphincterotomy and manual dilatation of anus techniques are effective.

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Nikhat, Ahemadi Firdous, and Mohd Zaheeruddin Ather. "Results of tailored lateral sphincterotomy for chronic fissure in-ano." International Surgery Journal 6, no. 11 (October 24, 2019): 3947. http://dx.doi.org/10.18203/2349-2902.isj20195101.

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Background: Fissure-in-ano is one of the common and most painful anorectal conditions encountered in surgical practice. Inspite of several conservative treatment options, surgical treatment in the form of lateral anal sphincterotomy remains the gold standard of treatment for chronic anal fissure, however it is associated with the significant rate of incontinence. This study reviews using a tailored lateral sphincterotomy by selecting the height of internal sphincter to be divided with aim of preserving more sphincter and hence reducing the incontinence rates.Methods: The study was carried out in 50 patients who were diagnosed clinically as chronic anal fissure attending Surgery department of ESIC medical college and hospital, Kalburagi over a period of 6 months from January 2019 to August 2019. Tailored left lateral internal sphincterotomy was performed in all patients. The date was recorded and analysed. Early post-operative follow-up was maintained every week for four weeks or till the fissure healed. Complications mainly incontinence rate was assessed.Results: Common age group was third and fourth decade of life. Pain (100%) was the commonest symptom. Majority of the patients (96%) had posterior fissure. Postoperatively about 97% patients had complete pain relief. Only one patient (2%) in the study reported incontinence to flatus during the first follow-up visit and had minor incontinence and other minimal complications were found.Conclusions: Tailored lateral anal internal sphincterotomy is safe and effective surgical procedure for the management for chronic anal fissure with lower rate of incontinence rate compared to gold standard lateral internal sphincterotomy.

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Azhar, Raheel, Aabya Salim, Raazia Ramzan, Areeba Mahmood, Saad ,. Aslam, and Sidra Riaz. "A Comparative Study of Lateral Sphincterotomy Vs Topical Application of Glyceryl Trinitrate 0.2% in the Treatment of Chronic Anal Fissure an Observational Study." Pakistan Journal of Medical and Health Sciences 16, no. 11 (November 30, 2022): 586–87. http://dx.doi.org/10.53350/pjmhs20221611586.

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0.2% Glyceryl trinitrate is vastly used for treatment of chronic anal fissure and it has proven its effectiveness by decreasing anal tone and promoting healing. However, lateral sphincterotomy is considered a standard treatment for anal fissures. OBJECTIVE: The aim of our study was to compare application of 0.2% GTN and lateral sphincterotomy as a treatment for chronic anal fissure. STUDY DESIGN: It was an observational prospective cohort study. METHODOLOGY: This study was conducted in General Surgery unit 2 of Dow University Hospital Ojha, Karachi. A total of 192 participants were included in the study with their signed consent 96 of whom were given GTN and the remaining 96 were advised lateral sphincterotomy RESULTS: Both treatment modalities showed promising results. Upon follow up after 2 and 4 weeks, patients’ symptoms decreased more in the lateral spincterotomy group. Around 29.17% patients became asymptomatic at 2weeks and 87.5% at 4 weeks in the lateral spincterotomy group. While 11.46% became asymptomatic at 2 weeks and 87.5% at 4 weeks in the conservative management group. CONCLUSION: Lateral sphincterotomy shows more effective results in treating chronic anal fissure as compared to application of 0.2% GTN however, as 0.2% GTN has quite comparable results as well, surgeons should opt for it as the first line of management before resorting to lateral sphincterotomy. Keywords: Chronic anal fissure, 0.2% Glyceryl Trinitrate, lateral sphincterotomy.

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Sendino, Oriol, Alejandro Fernández-Simon, Ryan Law, Barham Abu Dayyeh, Michael Leise, Karina Chavez-Rivera, Henry Cordova, et al. "Endoscopic management of bile leaks after liver transplantation: An analysis of two high-volume transplant centers." United European Gastroenterology Journal 6, no. 1 (May 25, 2017): 89–96. http://dx.doi.org/10.1177/2050640617712869.

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Background Bile leak after liver transplantation (LT) is commonly treated with endoscopic retrograde cholangiopancreatography (ERCP); however, there are limited data regarding the optimal treatment strategy. Objective We aimed to examine the role of ERCP in LT recipients with bile leaks at two large institutions. Methods We reviewed all ERCPs performed in LT recipients with bile leak and duct-to-duct biliary anastomosis at two high-volume transplant centers. Results Eighty patients were included. Forty-seven (59%) patients underwent ERCP with plastic stent placement (with or without sphincterotomy) and 33 patients (41%) underwent sphincterotomy alone. Complete resolution was obtained in 94% of the stent group vs. 58% of the sphincterotomy group ( p < 0.01). There was no difference in three-month survival among both groups. Percutaneous transhepatic therapy and surgery were required in 4% and 6% in the stent group vs. 12% and 42% in the sphincterotomy group, respectively ( p = 0.22 and p < 0.001). The only predictive factor of bile leak resolution was stent placement. Conclusion ERCP with plastic stent placement is highly successful and more effective than sphincterotomy alone for post-LT bile leak treatment. These results indicate that ERCP and plastic stent placement should be considered the standard of care for the treatment of bile leaks in LT.

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Coelho-Prabhu, Nayantara, and Todd Baron. "Cannulation Success and Complications When Performing Precut Sphincterotomy Using a Needle-Knife Converted from a Standard Biliary Sphincterotome." American Journal of Gastroenterology 106 (October 2011): S59. http://dx.doi.org/10.14309/00000434-201110002-00146.

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Stiegmann, Gregory V. "Bile Duct Calculi – The New Challenges." HPB Surgery 10, no. 6 (January 1, 1998): 409–10. http://dx.doi.org/10.1155/1998/16548.

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Background: Morbidity and mortality after surgical treatment of bileduct stones increase with age and associated diseases. A proposed alternative therapy is endoscopic sphincterotomy (ES) with the gallbladder left in situ, and we elected to compare this option with standard open surgery in high-risk patients.Methods: 98 patients (mean age 80 years) with symptoms likely to be due to bileduct stones or a recent episode of biliary parcreatitis were randomised to be treated either by open cholecystectomy with operative cholangiography and (if necessary) bileduct exploration (n=48) or by endoscopic sphincterotomy alone (n=50).Findings: The procedure was accomplished successfully in 94% of the surgery group and 88% of the ES group, and there were no significant differences in immediate morbidity (23% vs 16%) or mortality (4% vs 6%). During mean follow-up of 17 months biliary symptoms recurred in three surgical patients, none of whom underwent repeat surgery, and in 10 ES patients, seven of whom had biliary surgery. By multivariate regression analysis endoscopic sphincterotomy was an independent predictor of recurrent biliary symptoms (odds ratio 6.9; 95% C11.46 to 32.54).Interpretation: In elderly or high-risk patients, surgery is preferably to endoscopic sphincterotomy with the gallbladder left in situ as a definitive treatment for bileduct stones or non-severe biliary pancreatitis.

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Sritharan, Hariharan, Naren Kumar Ashok Kumar, and Mohamed Ismail Syed Ibrahim M. S. "Single centre randomized comparative trial of lateral internal sphincterotomy versus 2% diltiazem in chronic anal fissure." International Surgery Journal 7, no. 6 (May 26, 2020): 1723. http://dx.doi.org/10.18203/2349-2902.isj20202089.

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Background: Anal fissures are often encountered in surgical practice with surgery the gold standard management for chronic anal fissures. Recently the widespread use of pharmacologic agents for chronic fissures has increased. In our study we compare topical 2% diltiazem with lateral sphincterotomy with respect to symptoms such as relief of pain, ulcer healing, and side effects of treatments.Methods: A prospective comparative study, a total of 80 patients were randomized into 2 groups 40 each. Group A patients were subjected to open internal lateral sphincterotomy and group B to 2% topical diltiazem. The patients in both groups were followed up at 1st, 4th, 14th weeks and 6 months in OPD and were assessed for pain, sphincter tone and complications.Results: In group A (lateral anal sphincterotomy), patients achieved a good pain relief with a mean pain score of 1.98 by one week post procedure whereas group B (2% diltiazem) had taken 14 weeks to achieve similar pain relief (pain score of 1.5). At the end of 6 months, healing of fissure was noted in 100% of group A and in 90% of group B. 4 patients (10%) had recurrences in group B. Flatus incontinence was reported in 2 patients (5%) in group A although transient.Conclusions: Lateral anal sphincterotomy is superior to 2% diltiazem especially in healing of fissure, pain relief, quality of life and recurrence. Pharmacologic agents should be reserved for patients who are unfit or unwilling for surgery or can be used as a bridge therapy till sphincterotomy can be planned.

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Akool, Mohamed Abdzaid, Samer Makki Mohamed Al-Hakkak, and Alaa Abood Al-Wadees. "The Role of Endoscopic Retrograde Cholangiopancreatography in the Management of Biliary Complication Post-Laparoscopic Cholecystectomy." Open Access Macedonian Journal of Medical Sciences 9, B (May 14, 2021): 313–17. http://dx.doi.org/10.3889/oamjms.2021.6071.

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BACKGROUND: Laparoscopic cholecystectomy considers a golden surgery for gallbladder removal nowadays, and it carries some complications like biliary injuries, which can manage successfully by endoscopic retrograde cholangiopancreatography. AIM: To estimate the role of endoscopic management of bile duct injury (BDI) following laparoscopic cholecystectomy. PATIENT AND METHODS: A prospective study conducted at Al-Sader Medical City, Najaf City, Iraq, during the period between September 2018 and December 2020, included 44 patients complicated by the biliary injury resulting in a persistent biliary leak and/or jaundice after laparoscopic cholecystectomy and evaluated by endoscopic retrograde cholangiopancreatography (ERCP). RESULTS: Findings revealed that 25% of cases had complete BDI, only one managed by plastic stent placement, the other 10 referred for open surgical constructions, 61% had partial injury associated with the biliary leak, all managed by sphincterotomy and plastic stent placement through ERCP, almost 7% had a partial clipping of bile duct all managed with sphincterotomy, balloon dilatation/stone extraction, and plastic stent placement, 5% had slipped clips of cystic duct stump, are managed with sphincterotomy and plastic stent placement. Moreover, only one patient, 2%, had distal common bile duct stone with bile leak, managed by sphincterotomy and stone extraction. CONCLUSIONS: Laparoscopic cholecystectomy, a gold standard therapeutic option for symptomatic cholecystolithiasis, is associated with an increased risk of biliary injury due to many factors. ERCP is a safe means of diagnosing the cause of bile leakage after laparoscopic cholecystectomy. It also offers definitive treatment in most cases by endoscopic sphincterotomy and plastic stent placement.

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Dey, Dhrubajyoti, and Gopinath Pai. "Prospective comparative study between lateral sphincterotomy and subcutaneous fissurectomy with topical 2% diltiazem gel in the treatment of chronic fissure in ano." International Surgery Journal 6, no. 7 (June 29, 2019): 2571. http://dx.doi.org/10.18203/2349-2902.isj20192995.

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Background: Anal fissure is defined as an ulcer in the anoderm usually in the posterior midline, less frequently in the anterior midline and rarely in the lateral position of the anal canal. Different treatment modalities include non-invasive pharmacological therapies, lateral internal sphincterotomy (LIS) which is the gold standard for treatment and new therapies that include perineal support devices, Gonyautoxin injection, fissurectomy, fissurotomy, sphincterolysis, and flap procedures. Thus, aim of the study was to compare the efficacy of outcome of lateral internal sphincterotomy and subcutaneous fissurectomy with topical 2% Diltiazem gel in the treatment of chronic fissure in ano.Methods: 50 patients with chronic fissure in ano attending OPD of Department of General Surgery, KVGMCH, Sullia were randomly selected and divided into Group A (n=25): Lateral internal sphincterotomy (control group) and Group B (n=25): Subcutaneous fissurectomy + topical 2% Diltiazem Gel (test group).Results: Patients of Group B showed much less mean duration of absenteeism (2.88 weeks) compared to Group A. Comparison between Group B and Group A showed statistically significant differences in pain relief (P<0.0001), complications (p=0.03), mean duration of sitz baths (p<0.0001), absenteeism (p<0.0001) respectively.Conclusion: Hence Subcutaneous fissurectomy with topical 2% Diltiazem gel is a better surgical option for chronic fissure in ano than conventional Lateral internal sphincterotomy.

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HASHMAT, AZEEM, and TAHIRA ISHFAQ. "LATERAL INTERNAL SPHINCTEROTOM." Professional Medical Journal 16, no. 03 (September 10, 2009): 327–31. http://dx.doi.org/10.29309/tpmj/2009.16.03.2779.

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Objective: To evaluate the efficacy of lateral internal sphincterotomy in fissure in-ano. Design: This study is a prospective clinicaltrial. Place a n d Duration: It was conducted initially at D.H.Q./ Allied Hospital (PMC) Faisalabad and then other centers from November 2001to onward for the period of six years. Patients a n d M e t h o d s : 140 patients, in urgency due to sever pain, non-compliance to conservative andpharmacological management, or their preference were treated by lateral internal sphincterotomy. The patients were followed up at 1 st to 12thweeks. The extent of improvement in presenting symptoms and complications were noted on questionnaires. Results: Lateral internalsphincterotomy relieved 140 (100%) patients. Transient incontinence of flatus was present in 64.3%, at 1st week that was resolved at 8-12thweeks. There was no recurrence in other complications included infection 7.1%, abscess 7.1% and anesthesia related problems in 14.2 %.C o n c l u s i o n : Lateral internal Sphincterotomy may be regarded as "The Gold Standard"

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Afzal, Ammarah, Kamran Zaib Khan, Gul-E. Lala, Mian Umar Javaid, Khushbakht Ali Khan, and Laiq Folad. "Does Lateral Internal Sphincterotomy Impact the Outcome of Haemorrhoidectomy." Pakistan Journal of Medical and Health Sciences 16, no. 7 (July 30, 2022): 296–97. http://dx.doi.org/10.53350/pjmhs22167296.

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Background: The most common complication after hemorrhoidectomy is almost always postoperative. This dreadful complication makes the patients postpone the treatment even for prolapsing, bleeding, and uncomfortable piles. There are different methods that can be used for reducing pain including performing a lateral internal sphincterotomy (LIS). Better outcome of hemorrhoidectomy combined with lateral internal sphincterotomy has been observed in a few past controlled trials with respect to decreased pain after surgery, and improved and early wound healing. Objective: To compare the mean post-operative pain score in patients undergoing open hemorrhoidectomy with and without lateral internal sphincterotomy for III and IV degree hemorrhoids. Study Design: Randomized control trial. Place and Duration of Study: Department of Surgery, Jinnah Hospital Lahore from 1st July 2021 to 31st December 2021. Methodology: One hundred and twenty patients with diagnosis of III & IV degree hemorrhoids were selected. They were divided in two groups, Group A included patients who underwent open hemorrhoidectomy with lateral sphincterotomy and Group B included patients who underwent open hemorrhoidectomy alone. Standard Milligan Morgan Hemorrhoidectomy was done under local anesthesia. A fine surgical blade was inserted in inter-sphincteric groove with blade parallel to the circular fibers of internal sphincter. Blade was then rotated so that it faces the lumen of the anal canal. With the surgeon’s index finger in the canal, the blade was advanced towards the index finger so as to divide the internal sphincter but not the anal mucosa. Post-operative pain was assessed at first 48 hours post operatively according to ‘Visual Analog Score’. Results: The mean age was 34.6±7.72 in Group A and 34.28±8.09 years in Group B. There were 34 (56.67%) males in Group A and 32 (53.33%) in Group B while 26 (43.33%) females in Group A and 28 (46.67%) in Group-B. The mean pain score was 1.43±0.49 in Group A and 2.03±0.74 in Group B (P=0.001). Conclusion: Open hemorrhoidectomy with lateral sphincterotomy results in significantly lower mean post-operative pain when compared to open hemorrhoidectomy alone Keywords: Hemorrhoids, Open hemorrhoidectomy, Lateral sphincterotomy, Post-operative pain

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Teoh, Anthony Y., Frances K. Cheung, Philip W. Chiu, Simon K. Wong, Enders K. Ng, and James Y. Lau. "173 Combined Sphincterotomy and Balloon Dilation (ESBD) Versus Standard Sphincterotomy (ES) in Retrieval of Large Bile Duct Stones. A Randomized Controlled Trial." Gastrointestinal Endoscopy 73, no. 4 (April 2011): AB116—AB117. http://dx.doi.org/10.1016/j.gie.2011.03.024.

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Foutch, P. Gregory. "A prospective assessment of results for needle-knife papillotomy and standard endoscopic sphincterotomy." Gastrointestinal Endoscopy 41, no. 1 (January 1995): 25–32. http://dx.doi.org/10.1016/s0016-5107(95)70272-5.

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Arslanbekova, K. I., R. Yu Khryukin, and E. E. Zharkov. "ANOPLASTY AND LATERAL INTERNAL SPHINCTEROTOMY FOR CHRONIC ANAL FISSURE (systematic review and meta-analysis)." Koloproktologia 19, no. 4 (December 16, 2020): 115–30. http://dx.doi.org/10.33878/2073-7556-2020-19-4-115-130.

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INTRODUCTION: Lateral internal sphincterotomy (LIS) is considered the ‘gold standard’ therapy for chronic anal fissure (CAF). Advantages of LIS over other surgical techniques include higher rate of healing and lower risk of fissure recurrence. However, this procedure is associated with a high risk of anal sphincter insufficiency (ASI) in the postoperative period. Anal advancement flap (AAF) is an alternative surgical procedure for CAF, which requires the use of local flaps. Anal advancement flap is associated with a significantly lower risk of anal incontinence.AIM: to compare short-term and long-term outcomes of аnal advancement flap and lateral internal sphincterotomy in patients with chronic anal fissure.METHODS: a systematic review and meta-analysis of studies comparing outcomes of Anal advancement flap and lateral internal sphincterotomy was conducted. We evaluated the following parameters: the rate of epithelialization, the rate of anal sphincter insufficiency, and the rate of postoperative complications. We carried out statistical analysis using the Review Manager software (Review Manager 5.3.)RESULTS: the systematic review included four studies that presented the results of 278 patients. Compared with LIS, the odds for healing after AAF were 63% lower (OR=0.37; CI=0.19;0.74; P<0.005). We found no significant differences in the rate of postoperative complications (OR=1.43; CI=0.54;3.78; P=0,47). Compared with AAF, the odds for anal incontinence after LIS were 94% greater (OR=0.06; CI=0.01;0.37; P=0,002).CONCLUSION: both lateral internal sphincterotomy and аnal advancement flap are effective in curing CAF. However, considering the ambiguity and poor quality of data from the studies comparing these procedures, a high risk of bias for comparison groups and heterogeneity of the studies, one should interpret the results with caution; the aforementioned limitations dictate the need for further research.

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Vagholkar, Ketan. "Graded therapeutic approach to fissure in ano: study of 50 cases." International Surgery Journal 6, no. 11 (October 24, 2019): 3951. http://dx.doi.org/10.18203/2349-2902.isj20195102.

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Background: Fissure in ano is one of the commonest disease affecting all age groups. The condition is quite painful leading to interference in activities of daily living. A wide variety of modalities ranging from medical to surgical approaches have been proposed. However no single modality can be called the gold standard of treatment. Hence the need to develop an optimum graded approach to manage the condition.Methods: Fifty consecutive cases of fissure in ano presenting in an acute state were studied prospectively to develop a therapeutic algorithm for rational treatment of the painful condition.Results: Conservative treatment was commenced in all cases. Eighteen required anal dilatation while out of these eighteen patients, ten required sphincterotomy despite anal dilatation. Four patients had recurrence of symptoms despite all surgical treatments.Conclusions: Conservative treatment still has a significant and positive outcome in fissure in ano. Anal dilatation and sphincterotomy are the next options of treatment. Therefore a graded multimodal approach is therapeutic in treating fissure in ano.

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Sharma, Vishal, K. V. Raghavendra Prasada, Harish Kancharla, Ravi Sharma, Surinder S. Rana, and Deepak K. Bhasin. "Pancreatic pleural effusion due to ductal disruption upstream of a tight ductal stricture in patient with chronic calcific pancreatitis: Successful management with pancreatic sphincterotomy and dilatation of ductal stricture by Guide Wire." Journal of Digestive Endoscopy 06, no. 02 (April 2015): 066–69. http://dx.doi.org/10.4103/0976-5042.159239.

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AbstractEndoscopic therapy has evolved as the standard of care for pancreatic pleural effusion and pancreatic ascites. Endoscopic retrograde cholangiopancreatography and bridging the disruption of ductal disruption with stent placement is the treatment of choice. However, it may not be always possible to negotiate tight pancreatic duct (PD) strictures or stricture stone complex, and endoscopic sphincterotomy alone may not be sufficient. We report a 53-year-old male who had chronic calcific pancreatitis with bilateral pancreatic pleural effusion and a tight stricture at head body junction, across which conventional endoscopic accessories could not be negotiated except for the 0.035 inch guidewire, which we kept across the stricture for 48 h for guidewire induced stricture dilation. This led to the complete resolution of symptoms and pancreatic pleural effusion. Combination of endoscopic sphincterotomy and guide wire induced stricture dilation can be used as rescue technique in cases of very tight PD strictures with complications such as pancreatic pleural effusion.

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Zulfikar, Afiya, Usman Qureshi, Muhammad Salman Shafique, and Jahangir Sarwar Khan. "Comparison of hemorrhoidectomy versus hemorrhoidectomy and internal sphincterotomy in terms of postoperative pain." Professional Medical Journal 27, no. 04 (April 10, 2020): 677–81. http://dx.doi.org/10.29309/tpmj/2020.27.05.221.

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Objectives: To compare open hemorrhoidectomy with internal sphincterotomy versus open hemorrhoidectomy alone in terms of frequency of the postoperative pain. Study Design: Randomized Controlled Trial. Setting: Surgical Unit - I, Holy family Hospital, Rawalpindi. Period: For one year i.e. from January 2016 to December 2016. Material & Methods: 250 patients were divided in two equal groups by lottery method. The surgical procedure was performed using standard protocols after obtaining written informed consent. Anal dilatation was done after open hemorrhoidectomy in patients of control group (Group A). In the study group (Group B), the patients were subjected to lateral internal sphincterotomy after completion of classical open hemorrhoidectomy. Postoperative pain score was recorded by using visual analog scale. Difference between both groups for pain was analyzed using chi-square test. Results: There were 68 males and 57 females in Group-A and 61 males and 64 females in Group-B. The mean age of patients in Group-A was 33.10±8.77years and in Group-B was 32.52±9.4years. The mean pain score of patients in Goup-A and Group-B was 2.82±2.51 and 1.59±1.58 respectively (P<0.05). In Group-A, 94 (75.2%) cases had no pain while in Group-B, 116 (92.8%) cases were pain free following the procedure. The difference between both groups was significant i.e. P < 0.05. Conclusion: Open hemorrhoidectomy with internal sphincterotomy is effective in reducing postoperative pain.

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Kröner, Paul, Ivan Jovanovic, Marco DʼAssunção, and Klaus Mönkemüller. "A Simple ex vivo, Biologic ERCP Training Model for Standard and Precut Biliary Sphincterotomy." American Journal of Gastroenterology 110 (October 2015): S679. http://dx.doi.org/10.14309/00000434-201510001-01574.

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Mahabub, Md, Md Mahbubur Rahman, Md Tanvirul Islam, and Selina Sultana. "A Comparison between the Results of Open versus Closed Lateral Internal Sphincterotomy in the Surgical Management of Chronic Anal Fissure." BIRDEM Medical Journal 8, no. 3 (September 10, 2018): 235–39. http://dx.doi.org/10.3329/birdem.v8i3.38130.

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Background: Lateral internal sphincterotomy is regarded as the gold standard surgical treatment for chronic anal fissure. Some authors reported that the closed technique had lower complication rates than that by the open technique, but others reported that both of the techniques had no meaningful differences in complications.Methods: This was a comparative and cohort study carried out at Department of Colorectal Surgery, Combined Military Hospital (CMH) Dhaka, Bangladesh, from October 2013 to October 2017. Eighty three patients with chronic anal fissure not responding to medical treatment for at least three months were included in this study to compare the results of the open versus closed techniques of lateral internal sphincterotomy after four months follow up postoperatively.Results: The mean age at presentation was 34.15±11.4 years and the male to female ratio was 1.24:1. The results of open and closed techniques were compared regarding per-operative bleeding (35.71% versus 12.19%), post-operative urinary retention (4.76% versus 0%), symptom relief on first post-operative day (76.19% versus 70.73%), significant 1st post-operative day pain in the operated wound (33.33% versus 7.31%), temporary fecal soiling (2.38% versus 0%), temporary flatus incontinence (7.14% versus 0%), and fissure recurrence (0% versus 14.63%) respectively. Temporary incontinence to fecal and flatus recovered by conservative management within two and four months of surgery respectively.Conclusion: The closed technique of lateral internal sphincterotomy had lower post-operative complications, pain, bleeding, and incontinence compared to open technique, but increased risk of fissure recurrence.Birdem Med J 2018; 8(3): 235-239

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Lee, Se Joon, Jong Won Song, Jun Pyo Chung, Yukihiro Sato, Yutaka Sekine, Toshihiko Higashizawa, Kenichi Ido, and Kentaro Sugano. "4617 Type of electric current for standard endoscopic sphincterotomy does not determine the type of complication." Gastrointestinal Endoscopy 51, no. 4 (April 2000): AB185. http://dx.doi.org/10.1016/s0016-5107(00)14464-5.

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Faizan, Muhammad, Saeed Ahmad, Zainab Zafar, Muhammad Khurram Zia, and Maria Shaikh. "Efficacy of Lateral Internal Sphincterotomy in Treating Chronic Anal Fissure." Pakistan Journal of Medical and Health Sciences 16, no. 1 (January 30, 2022): 1138–40. http://dx.doi.org/10.53350/pjmhs221611138.

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Aim of the study: To determine the effectiveness of lateral internal sphincterotomy in the treatment of chronic anal fissures resistant to pharmacological treatment (chemical sphincterotomy) in terms of recovery time, frequency of recurrences and complications. Study design: This was a prospective descriptive study. Place and duration:In the Department of Surgery,Lahore General Hospital, Lahore during the time period fromJanuary 2021 to August 2021. Material and methods: The study included 80 patients with chronic anal fissure, regardless of age and sex, after the history and clinical examination. All these patients were operated on under general or spinal anesthesia after obtaining consent and routine examinations. Lateral internal sphincterotomy was performed and patients with OPD were followed for 6 to 8 weeks to determine the benefit of the procedure. Results: The study included 57 men and 23 women (M: F ratio 2.2: 1) with a history of pain, bleeding, discharge with or without sentinel tagduring defecation. The average age was 36 and ranged from 20 to 55. The fissure was found in the majority of patients at 6 O clock position (91.2% for men and 52.2% for women). The duration of symptoms was longer in women due to social problems. LIS was used in all patients. Patients were followed in OPD at weeks 1, 2, 4 and 6. Most of the patients fully recovered after 4 weeks. Occasional constipation occurred in 31 (54.4%) men and 11 (47.8%) women. The study found crater ulcers in all 80 patients. All patients had a history of painful bowel movements (100%), but 24 men (42.1%) and 12 women (52.2%) had bleeding and discharge. In 51 male patients (89.5%), the fissure was in the posterior and anterior midline in 3 patients (13.1%). Half of the patients had anterior fissure and the other half had posterior fissures. The sentinel tag was observed in 46 (80.7%) men and 17 (73.9%) women. 11 (19.3%) men and 6 (26.1%) women reported liquid stool incontinence, while 15 men (26.3%) and 9 women (16.9%) reported flatus incontinence. No relapse was observed in all patients after 4 months. Conclusion: As long as the patient is willing to accept the risk of transient fecal incontinence, we can accept the Gold Standard of Treatment (LIS) as first-line therapy for chronic anal fissure. Keywords: Lateral internal sphincterotomy, Chronic anal fissure, Fecal incontinence.

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Kent, Ilan, Hayim Gilshtein, and Steven D. Wexner. "Fisura anal: anatomía, patogenia y tratamiento." Revista Argentina de Cirugía 112, no. 4 (December 1, 2020): 388–96. http://dx.doi.org/10.25132/raac.v112.n4.anwex.

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Anal fissure is a common anorectal condition. While it often presents as a small oval tear in the anoderm, it can cause significant pain and anguish to the patient. The exact etiology is still debatable but increased anal tone is associated with most fissures. The initial management is medical with agents intended to reduce the anal tone. More chronic fissures usually require surgical intervention. Lateral internal sphincterotomy has a high success rates and is considered the gold standard of interventions. In this article we review the relevant anatomy, pathophysiology and contemporary treatment options for anal fissures.

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Mushtaque, Majid, Umar Q. Bacha, Arshad Rashid, Tajamul N. Malik, and Samina A. Khanday. "Outcome of bilateral versus unilateral lateral internal sphincterotomy for chronic anal fissures." International Surgery Journal 6, no. 6 (May 28, 2019): 2154. http://dx.doi.org/10.18203/2349-2902.isj20192384.

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Background: Gold standard treatment for chronic anal fissure is lateral internal sphincterotomy (LIS) which is usually performed at a single location. This randomized study compares bilateral to unilateral lateral internal sphincterotomy.Methods: Patients were randomized into two equal groups (64 each) to undergo either bilateral (Group A) or unilateral (Group B) open lateral internal sphincterotomy (LIS). Comparative study was done in terms of symptomatic relief of pain, incontinence, complete healing of fissure, and recurrence. Chi-square test was used as a test of significance.Results: Both groups had comparable demographic and clinical characteristics. Mean operative time for was longer for bilateral LIS (P-value <0.05). Mean pain score (VAS) in bilateral LIS group was lower in early post-operative period (P-value <0.05). At the end of 4th week 65.6% of patients in bilateral LIS group and 56.25% of patients in unilateral LIS group had completely healed fissures (P-value <0.05). Mean Wexner score for incontinence was comparable, while significant decrease in resting anal pressure was noted at 1 month in BLIS group. There was one recurrence in unilateral LIS group.Conclusions: Bilateral LIS resulted in better outcome in terms of early pain relief, early reduction of anal pressures, complete healing rate in 4 weeks with no recurrence. It does not increase the risk of incontinence and has better patients’ satisfaction as compared to unilateral LIS.

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Lee, Tae Yoon. "Recent Update of Accessories for ERCP." Korean Journal of Pancreas and Biliary Tract 26, no. 2 (April 30, 2021): 77–84. http://dx.doi.org/10.15279/kpba.2021.26.2.77.

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Endoscopic retrograde cholangiopancreatography (ERCP) became the standard method of choice for the management of patients with a variety of benign and malignant pancreaticobiliary disorders. A growing range of ERCP accessories has been developed to support the increasing demands and complexity of therapeutic ERCP. Various accessories are needed from selective cannulation to the removal of bile duct stones which involves endoscopic sphincterotomy or endoscopic papillary (large) balloon dilation with a balloon or basket-assisted stone extraction. Detailed knowledge and correct usage of accessories are essential to ensure optimal patient care and safety. This review describes current accessories that are available to use during diagnostic and therapeutic ERCP.

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Archibugi, Livia, Alberto Mariani, Gabriele Capurso, Mariaemilia Traini, Maria Chiara Petrone, Gemma Rossi, Sabrina Gloria Giulia Testoni, Pier Alberto Testoni, and Paolo Giorgio Arcidiacono. "Needle-knife fistulotomy vs. standard biliary sphincterotomy for choledocholithiasis: common bile duct stone recurrence and complication rate." Endoscopy International Open 07, no. 12 (December 2019): E1733—E1741. http://dx.doi.org/10.1055/a-1024-3789.

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Abstract Background and study aims With common bile duct (CBD) stones, access to the CBD can be achieved through the papilla orifice followed by standard biliary sphincterotomy (SBS), or through precut fistulotomy (PF) in case of difficult cannulation. The two methods alter papilla anatomy differently, potentially leading to a different rate of stone recurrence. No data have been published on stone recurrence after PF in patients with CBD stones. The aim of this study was to evaluate CBD stone recurrence, reintervention rate after PF versus SBS, and complications. Patients and methods This was a retrospective single-center cohort study including patients undergoing for the first time endoscopic retrograde cholangiopancreatography (ERCP) for CBD stones with PF in case of failed repeated cannulation attempts, matched for sex/age to patients with SBS randomly extracted from our database. T-test and Fisher’s tests were used for continuous and categorical variable comparison. Recurrence probability was calculated with Kaplan–Meier curve. Factors associated with ERCP repetition were evaluated with logistic regression through a Cox’s proportional hazards model. Results Eighty-five patients with PF were included, with 85 matched controls (mean age 68.7 years, 45.9 % males). Overall, patients with PF had the same reintervention rate as those with SBS (14.1 % vs. 12.9 %) with a hazard ratio (HR) of 1.11 (95 % CI 0.49 – 2.50; P = 0.81), but mean time to reintervention was significantly lower (74.9 ± 74.6 vs. 765.6 ± 961.3 days; P < 0.0001), with 100 % of stones recurring within the first year in the PF group vs. 54.5 % in the SBS group (P = 0.01). The only factor associated with ERCP repetition risk was incomplete CBD clearing. Complications, including pancreatitis, did not differ significantly. Conclusions The reintervention rate was significantly higher in the short term after PF. Therefore, closer follow-up in the first 6 to 12 months after ERCP might be appropriate for patients underoing PF.

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Ahmed, Mukhtiar, Jamil Akhter Munir Ahmad, Muhammad Ali Sheikh, Tariq Latif, and Abdul Qayyum. "Topical Lignocaine with Diltiazem or Glyceryltrinitrate for Paediatric Acute Anal Fissure: A Randomized Clinical Trial." Proceedings of Shaikh Zayed Medical Complex Lahore 34, no. 4 (November 5, 2020): 70–75. http://dx.doi.org/10.47489/p000s344z774mc.

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Introduction: Anal fissure is a common problem in children, the exact etiology of which is unknown and it mostly presents with painful defecation and bleeding per rectum. The standard treatment of anal fissure is lateral internal sphincterotomy but due to risk of fecal incontinence chemical sphincterotomy is used as alternative to surgical sphincterotomy. Aims & Objectives: To compare the effectiveness of topical diltiazem and lignocaine with glyceryl trinitrate and lignocaine in relieving of symptoms and healing of acute anal fissure in children. Place and duration of study: This study was conducted in the Department of Paediatric Surgery, Shaikh Zayed Hospital, Lahore & Department of Paediatric Surgery, Fatima Memorial Hospital, Lahore from September 2017 to September 2018. Material & Methods: Total 228 children were enrolled in the study and randomly divided in group A and B, 114 children in each group. Group A received topical 2% diltiazem cream and 2% lignocaine gel, while group B received topical 0.2% glyceryl trinitrate and 2% lignocaine gel, applied locally, twice daily. Results: There were 78(68.4%) male children in group A and 66(57.9%) in group B. All patients completed 6 week treatment course. The symptoms and condition of the anal fissure were evaluated before start of treatment and at subsequent follow up periods. In group A 55 (48.2%) cases completely healed by second week, while in group B, 33 (28.9%) cases healed. The number of completely healed cases at 4 weeks follow up in group A and group B were 91 (79.8%) and 69(60.5%) respectively, while at week 6 follow up this rate was 95 (83.3%) and 73 (64.0%) respectively. Symptomatic relief in painful defecation observed in group A and group B was 74(64.9%) and 55(48.2%) at week 2, 95(83.3%) and 74(64.9%) at week 4 while 95(83.3%) and 77(67.5%) at week 6 in two groups respectively. Conclusion: Use of combination of topical diltiazem and lignocaine for the treatment of acute anal fissure in paediatric population is preferred over combination of glyceryl trinitrate and lignocaine.

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El Muhtaseb, M. S., Nima Alfarra, Yaman Rabbaa, Esra'a Abuhannieh, Ghadeer Alsabateen, Walid Adel Zakaria Al Natsheh, and Mohammad AL Qudah. "Long-term Fecal incontinence after lateral internal sphincterotomy for anal fissure." Polish Journal of Surgery 94, no. 4 (January 26, 2022): 1–5. http://dx.doi.org/10.5604/01.3001.0015.7098.

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The background and purpose of the study An anal fissure is a common benign anal condition. The gold standard treatment is lateral internal sphincterotomy (LIS), and this procedure carries a risk of incontinence. The aim of this study is to determine the long-term risk of faecal incontinence after LIS. Method All patients who had LIS for chronic anal fissure between the years 2004 until 2010 were interviewed by phone and assessed for sphincter function (incontinence) using Wexner fecal incontinence score (WIS). Results Fifty-nine patients (34 females, 57.6%) with a mean follow-up duration of 10.6 years (range 8 – 15 years) were interviewed. Twelve patients (20.3 %) had a WIS score of one or more. The majority of the patient noticed the change in sphincter function years after the operation. There was no association between vaginal delivery and the WIS score result Conclusion The long-term risk of abnormal sphincter function after LIS appears to be higher than expected especially in the presence of multiple vaginal deliveries or systemic diseases such as Diabetes mellitus. A larger prospective study is required to establish a correct risk of incontinence in the long term.

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Hittelet, Axel, and Jacques Devière. "Management of Anticoagulants before and after Endoscopy." Canadian Journal of Gastroenterology 17, no. 5 (2003): 329–32. http://dx.doi.org/10.1155/2003/182398.

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The risk of procedure-related bleeding while taking anticoagulants needs to be weighed against the risk of thromboembolism from discontinuing these drugs. It is not necessary to adjust anticoagulation for low-risk procedures, such as upper endoscopy with biopsy, colonoscopy with biopsy or endoscopic retrograde cholangiopancreatography with stent insertion (but without sphincterotomy). Procedures that incur a high risk of bleeding include polypectomy, endoscopic sphincterotomy, laser therapy, mucosal ablation and treatment of varices. For these procedures, warfarin should be discontinued four to five days beforehand. Depending on the risk of thromboembolism, that is based on the nature of the underlying condition, the patient may require vitamin K and/or fresh frozen plasma (to ensure that coagulation parameters are within the normal range) or heparin infusions (to ensure that some degree of anticoagulation is maintained). Low molecular weight heparin is an alternative to unfractionated heparin for select cases with a high risk of thromboembolism. Warfarin therapy may generally be resumed on the night of the procedure and may be supplemented by heparin in patients with a high risk of thromboembolism. It is not necessary to discontinue acetylsalicylic acid or nonsteroidal anti-inflammatory drugs, when used in standard doses, for endoscopic procedures. There are insufficient data to make recommendations regarding newer antiplatelet drugs, such as ticlopidine or clopidogrel, but it is prudent to discontinue these medications seven to 10 days before a high-risk procedure.

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Goudar, Bhimanagouda Venkanagouda, Eshwar B. Kalburgi, Yamanur P. Lamani, and Veerabhadra Gowd Y. C. "Feasibility of local anaesthesia in lateral internal anal sphincterotomy for chronic anal fissure." International Surgery Journal 5, no. 7 (June 25, 2018): 2578. http://dx.doi.org/10.18203/2349-2902.isj20182777.

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Background: Fissure in Ano is one of the common and most painful anorectal conditions encountered in surgical practice. Inspite of several conservative treatment options, surgical treatment in the form of Lateral Anal Spincterotomy (LAS) remains the gold standard of treatment for Chronic Anal Fissures (CAF).Methods: Prospective comparative study conducted on 90 patients randomly divided into two groups Group A under Local anaesthesia (LA) and Group B under Spinal anaesthesia (SA) respectively. The primary outcome variables studied were postoperative pain, hospital stay, and cost effectiveness.Results: A total of 90 patients randomly divided into 45 patients in each group. There was no statistically difference in the pain at surgery, but post-operative pain was significantly less in LA group at 5th hour, 24 hours after surgery. Hospital stay in LA group is significantly less when compared to SA group (1.92, 3.75 respectively).Conclusions: LAS can be comfortably performed under LA with added advantages.

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Ryu, Jieun, Kyu-Hyun Paik, Chang-Il Kwon, Dong Hee Koh, Tae Jun Song, Seok Jeong, and Won Suk Park. "The Safety and Efficacy of an Unflanged 4F Pancreatic Stent in Transpancreatic Precut Sphincterotomy for Patients with Difficult Biliary Cannulation: A Prospective Cohort Study." Journal of Clinical Medicine 11, no. 19 (September 26, 2022): 5692. http://dx.doi.org/10.3390/jcm11195692.

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Prophylactic pancreatic stenting effectively reduces the rate and severity of post-ERCP pancreatitis (PEP) in the precut technique; however, studies on the optimal type and duration of the stent are still lacking. This prospective study evaluated the incidence and severity of PEP and the rate of spontaneous stent dislodgement in patients undergoing transpancreatic precut sphincterotomy (TPS) accompanied by prophylactic pancreatic stenting with an unflanged plastic stent (4F × 5 cm) for difficult biliary cannulation. A total of 247 patients with naïve papilla were enrolled in this study, and data were collected prospectively. In the final analysis, 170 and 61 patients were included in the standard cannulation technique and TPS groups, respectively. The incidence of PEP in the standard cannulation technique and TPS groups was 3.5% and 1.6% (p = 0.679), respectively. The technical success rate of selective biliary cannulation in the TPS group was 91.8%. The spontaneous dislodgement rate of the prophylactic plastic stent was 98.4%. In conclusion, an unflanged pancreatic stent (4F × 5 cm) placement in TPS for patients with failed standard cannulation technique is a safe and effective measure due to low adverse events and few additional endoscopic procedures for removing the pancreatic duct (PD) stent.

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Raza, Vishal Farid, Qaiser Mahmood, Iqra Waris, Muhammad Shahwaiz Malik, and Khalid Javeed Khan. "Modified Kenalog Protocol for Perianal Fissures- A Quasi Experimental Trial." Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University 18, no. 3 (September 11, 2022): 159–64. http://dx.doi.org/10.48036/apims.v18i3.639.

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Objective: To ascertain the role of triamcinolone injection at the base of an anal fissure and its effect on healing and pain relief. Methodology: A quasi-experimental study was conducted from November 2021 to February 2022. Under aseptic measures, a 1ml Triamcinolone 40mg/ml injection was administered at the base of the anal fissure using a 1cc insulin syringe. This was injected in four positions around the base of the fissure. Patients were followed for one week to assess pain relief and improvement in quality of life. Patients were assessed for quality of life improvement and satisfaction with treatment. Patients were offered lateral internal sphincterotomy at the end of one week and again on follow up after two weeks given they were not satisfied with pain relief or symptom recurrence occurred. Results: Twenty five patients were enrolled and analysed. All fissures were seen to have a red inflamed base at enrollment. At one week after treatment, a paler base with less signs of inflammation was observed. Patients reported a mean 70% improvement in their symptoms. A mean change of 16.45 points was seen in Brief Pain Inventory scores at one-week follow up. 25% underwent a lateral internal sphincterotomy. The number needed to treat was 2.5. 5 patients were lost to follow-up after the initial one week follow-up. Conclusion: Injection of Triamcinolone at the base of an anal fissure may have a role as an adjunct to standard management in treatment. It has been shown to decrease pain and enhance healing of the fissure thus decreasing the need for surgical intervention.

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Brisinda, Giuseppe, Maria Michela Chiarello, Anna Crocco, Anna Rita Bentivoglio, Maria Cariati, and Serafino Vanella. "Botulinum toxin injection for the treatment of chronic anal fissure: uni- and multivariate analysis of the factors that promote healing." International Journal of Colorectal Disease 37, no. 3 (February 11, 2022): 693–700. http://dx.doi.org/10.1007/s00384-022-04110-0.

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Abstract Purpose Anal fissure is caused by a pathological contraction of the internal anal sphincter. Lateral internal sphincterotomy remains the gold standard for the treatment of fissure. Botulinum toxin injections have been proposed to treat this condition without any risk of permanent injury of the internal sphincter. We investigate clinical and pathological variables and the effects of different dosage regimens of botulinum toxin to induce healing in patients with idiopathic anal fissure. Methods This is a retrospective study at a single center. The patients underwent a pre-treatment evaluation that included clinical inspection of the fissure and anorectal manometry. We collected and analyzed demographic data, pathological variables, associated pathological conditions, and treatment variables. Success was defined as healing of the fissure, and improvement of symptoms was defined as asymptomatic persistent fissure. Results The findings of 1003 patients treated with botulinum toxin injections were reported. At 2 months evaluation, complete healing was evident in 780 patients (77.7%). Resting anal tone (77.1 ± 18.9 mmHg) was significantly lower from baseline (P < 0.0001) and from 1-month value (P = 0.0008). Thirty-nine not healed patients underwent lateral internal sphincterotomy, and 184 were re-treated with 50 UI of botulinum toxin. In these patients, the healing rate was 93.9% (171 patients). Dose and injection site of toxin correlates with healing rate. There were no relapses during an average of about 71 months. Conclusion Our data show that injection of botulinum toxin into the internal anal sphincter is a safe and effective alternative to surgery in patients with chronic anal fissure.

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Attwell, Augustin, Christopher Lawrence, Robert H. Hawes, Peter B. Cotton, and Joseph Romagnuolo. "Endoscopic Pancreatic Sphincterotomy for Pancreas Divisum Using a Needle-Knife or Standard Pull-Type Technique: Safety and Reintervention Rates." Gastrointestinal Endoscopy 61, no. 5 (April 2005): AB187. http://dx.doi.org/10.1016/s0016-5107(05)01023-0.

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Hisa, Takeshi. "1060 Can Endoscopic Papillary Balloon Dilation With Minor Sphincterotomy Be a Standard Treatment for the Conventional Bile Duct Stone?" Gastrointestinal Endoscopy 81, no. 5 (May 2015): AB195. http://dx.doi.org/10.1016/j.gie.2015.03.1953.

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Troncone, Edoardo, Michelangela Mossa, Pasquale De Vico, Giovanni Monteleone, and Giovanna Del Vecchio Blanco. "Difficult Biliary Stones: A Comprehensive Review of New and Old Lithotripsy Techniques." Medicina 58, no. 1 (January 13, 2022): 120. http://dx.doi.org/10.3390/medicina58010120.

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Biliary stones represent the most common indication for therapeutic endoscopic retrograde cholangiopancreatography. Many cases are successfully managed with biliary sphincterotomy and stone extraction with balloon or basket catheters. However, more complex conditions secondary to the specific features of stones, the biliary tract, or patient’s needs could make the stone extraction with the standard techniques difficult. Traditionally, mechanical lithotripsy with baskets has been reported as a safe and effective technique to achieve stone clearance. More recently, the increasing use of endoscopic papillary large balloon dilation and the diffusion of single-operator cholangioscopy with laser or electrohydraulic lithotripsy have brought new, safe, and effective therapeutic possibilities to the management of such challenging cases. We here summarize the available evidence about the endoscopic management of difficult common bile duct stones and discuss current indications of different lithotripsy techniques.

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Sritharan, Hariharan, Naren Kumar Ashok Kumar, and Mohamed Ismail Syed Ibrahim. "Management of chronic anal fissures: a narrative review." International Surgery Journal 7, no. 4 (March 26, 2020): 1327. http://dx.doi.org/10.18203/2349-2902.isj20201420.

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Anal fissures are often encountered in surgical practice in both sexes. It is a distressing disease impacting quality of life and causes profound morbidity among those affected. If left untreated, it may lead onto perianal abscess or even malignancy in long standing cases. Surgery is the gold standard management for chronic anal fissures. Recently the widespread use of pharmacologic agents for chronic fissures has increased. The management of chronic anal fissures has migrated to an era of multifaceted approach. This narrative review looks into various studies spanning over a period of 16 years. Various articles were shortlisted and analyzed for efficacy of various treatment methods, their impact in hospital stay, quality of life improvement, recurrence rate and complications among various treatment methods. We concluded from this review, that open lateral internal sphincterotomy is still the gold standard method of treatment for chronic anal fissure. Among pharmacological agents, 2% diltiazem has the best effectiveness with good compliance rate. Modern surgical techniques like VY plasty can be reserved for special situations. We do not recommend the practice of manual anal dilatation.

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Dumonceau, Jean-Marc, Christine Kapral, Lars Aabakken, Ioannis S. Papanikolaou, Andrea Tringali, Geoffroy Vanbiervliet, Torsten Beyna, et al. "ERCP-related adverse events: European Society of Gastrointestinal Endoscopy (ESGE) Guideline." Endoscopy 52, no. 02 (December 20, 2019): 127–49. http://dx.doi.org/10.1055/a-1075-4080.

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Main Recommendations Prophylaxis 1 ESGE recommends routine rectal administration of 100 mg of diclofenac or indomethacin immediately before endoscopic retrograde cholangiopancreatography (ERCP) in all patients without contraindications to nonsteroidal anti-inflammatory drug administration.Strong recommendation, moderate quality evidence. 2 ESGE recommends prophylactic pancreatic stenting in selected patients at high risk for post-ERCP pancreatitis (inadvertent guidewire insertion/opacification of the pancreatic duct, double-guidewire cannulation).Strong recommendation, moderate quality evidence. 3 ESGE suggests against routine endoscopic biliary sphincterotomy before the insertion of a single plastic stent or an uncovered/partially covered self-expandable metal stent for relief of biliary obstruction.Weak recommendation, moderate quality evidence. 4 ESGE recommends against the routine use of antibiotic prophylaxis before ERCP.Strong recommendation, moderate quality evidence. 5 ESGE suggests antibiotic prophylaxis before ERCP in the case of anticipated incomplete biliary drainage, for severely immunocompromised patients, and when performing cholangioscopy.Weak recommendation, moderate quality evidence. 6 ESGE suggests tests of coagulation are not routinely required prior to ERCP for patients who are not on anticoagulants and not jaundiced.Weak recommendation, low quality evidence. Treatment 7 ESGE suggests against salvage pancreatic stenting in patients with post-ERCP pancreatitis.Weak recommendation, low quality evidence. 8 ESGE suggests temporary placement of a biliary fully covered self-expandable metal stent for post-sphincterotomy bleeding refractory to standard hemostatic modalities.Weak recommendation, low quality evidence. 9 ESGE suggests to evaluate patients with post-ERCP cholangitis by abdominal ultrasonography or computed tomography (CT) scan and, in the absence of improvement with conservative therapy, to consider repeat ERCP. A bile sample should be collected for microbiological examination during repeat ERCP.Weak recommendation, low quality evidence.

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Aivaz, Ohara, Jessica Rayhanabad, Vincent Nguyen, Philip I. Haigh, and Maher Abbas. "Botulinum Toxin A with Fissurectomy is a Viable Alternative to Lateral Internal Sphincterotomy for Chronic Anal Fissure." American Surgeon 75, no. 10 (October 2009): 925–28. http://dx.doi.org/10.1177/000313480907501013.

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Lateral internal sphincterotomy (LIS) is the gold standard surgical treatment for anal fissure. However, it carries potential complications, including fecal incontinence. The goal of this retrospective study was to compare the outcome of botulinum toxin A injection coupled with fissurectomy ([BTX + FIS) versus LIS. There were 59 patients who underwent BTX + FIS or LIS over a 5-year period. LIS was performed in the standard fashion without fissurectomy. BTX + FIS entailed internal sphincter injection with 80 units of botulinum toxin A coupled with fissurectomy. Forty patients underwent LIS and 19 had BTX + FIS. The choice of operation was based on the patient's preference. Primary healing rate was 90 and 74 per cent in the LIS and BTX + FIS groups, respectively ( P = 0.13). The complication rate was 10 per cent in the LIS vs 0 per cent in the BTX + FIS groups ( P = 0.29). Complications of LIS included anal sepsis in one patient and flatal and/or fecal incontinence in three patients. During a mean follow up of 19 months; recurrence rate was 0 and 5 per cent in the LIS and BTX+FIS groups, respectively ( P = 0.32). The results of this study demonstrate that BTX + FIS is a viable alternative to LIS for patients with chronic anal fissure and should be considered as an alternative first-line surgical therapy.

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Theodoropoulos, George E., Vasileios Spiropoulos, Konstantinos Bramis, Aris Plastiras, and George Zografos. "Dermal Flap Advancement Combined with Conservative Sphincterotomy in the Treatment of Chronic Anal Fissure." American Surgeon 81, no. 2 (February 2015): 133–42. http://dx.doi.org/10.1177/000313481508100224.

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Lateral internal sphincterotomy (LIS) is considered the surgical treatment of choice for chronic anal fissure (CAF). Flap techniques for fissure coverage have the advantage of primary wound healing, potentially providing better functional results and faster pain relief. The standard surgical strategy for CAF consisting of conventional LIS (CLIS) up tothe dentate line was modified by “tailoring” the LIS to the apex of the CAF, but never greater than 1 cm, and by advancing a dermal flap for coverage of the CAF (LIS + flap) after fissurectomy. Thirty consecutive patients who underwent “LIS + flap” were compared with 32 patients who had been previously treated by CLIS. A modified, trapezoidlike Y-V flap from perianal skin was advanced into the CAF base. Pain at the first postoperative day, pain at defecation during the first week, postoperative use of analgesics, and time for patients’ pain relief were significantly less at the “LIS + flap” group ( P < 0.01). Objective healing was achieved faster ( P < 0.01) and soiling episodes were less ( P < 0.05) after “LIS + flap.” The addition of a dermal flap after “conservative” LIS resulted in better healing and significantly less postoperative discomfort than the isolated application of CLIS.

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Attwell, Augustin, Gregory Borak, Robert Hawes, Peter Cotton, and Joseph Romagnuolo. "Endoscopic pancreatic sphincterotomy for pancreas divisum by using a needle-knife or standard pull-type technique: safety and reintervention rates." Gastrointestinal Endoscopy 64, no. 5 (November 2006): 705–11. http://dx.doi.org/10.1016/j.gie.2006.02.057.

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Ney, Marcus Vinicius Silva, Fauze Maluf-Filho, Paulo Sakai, Bruno Zilberstein, Joaquim Gama-Rodrigues, and Heitor Rosa. "Endoscopic ultrasound versus endoscopic retrograde cholangiography for the diagnosis of choledocholithiasis: the influence of the size of the stone and diameter of the common bile duct." Arquivos de Gastroenterologia 42, no. 4 (December 2005): 239–43. http://dx.doi.org/10.1590/s0004-28032005000400009.

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BACKGROUND: Endoscopic retrograde cholangiography is highly accurate in diagnosing choledocholithiasis, but it is the most invasive of the available methods. Endoscopic ultrasonography is a very accurate test for the diagnosis of choledocholithiasis with a risk of complications similar to that of upper gastrointestinal endoscopy. AIM: To compare the accuracy of endoscopic ultrassonography and endoscopic retrograde cholangiography in the diagnosis of common bile duct stones before laparoscopic cholecystectomy and to analyze endoscopic ultrasound results according to stone size and common bile duct diameter. PATIENTS AND METHODS: Two hundred and fifteen patients with symptomatic gallstones were admitted for laparoscopic cholecystectomy. Sixty-eight of them (31.7%) had a dilated common bile duct and/or hepatic biochemical parameter abnormalities. They were submitted to endoscopic ultrassonography and endoscopic retrograde cholangiography. Sphincterotomy and sweeping of the common bile duct were performed if endoscopic ultrassonography or endoscopic retrograde cholangiography were considered positive for choledocholithiasis. After sphincterotomy and common bile duct clearance the largest stone was retrieved for measurement. Endoscopic or surgical explorations of the common bile duct were considered the gold-standard methods for the diagnosis of choledocholithiasis. RESULTS: All 68 patients were submitted to laparoscopic cholecystectomy with intraoperative cholangiography with confirmation of the presence of gallstones. Endoscopic ultrassonography was a more sensitivity test than endoscopic retrograde cholangiography (97% vs. 67%) for the detection of choledocholithiasis. When stones >4.0 mm were analyzed, endoscopic ultrassonography and endoscopic retrograde cholangiography presented similar results (96% vs. 90%). Neither the size of the stone nor the common bile duct diameter had influence on endoscopic ultrasonographic performance. CONCLUSIONS: For a group of patients with an intermediate or moderate risk with respect to the likelihood of having common bile duct stones, endoscopic ultrassonography is a better test for the diagnosis of choledocholithiasis when compared to endoscopic retrograde cholangiography mainly for small-sized calculi.

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