title: Fissurectomy and isosorbide dinitrate for chronic fissure in ano not responding to conservative treatment.
abstract: BACKGROUND
  Although lateral sphincterotomy heals chronic fissure in ano in over 90 per cent of cases it is a surgical technique with inherent complications. To avoid such complications, chronic fissure in ano was treated by fissurectomy in this study. To enhance postoperative tissue perfusion allowing stable wound healing, fissurectomy was combined with temporary chemical sphincterotomy by a nitric oxide donor cream.
  
  
  METHODS
  Seventeen consecutive patients (ten women) with chronic fissure in ano not responding to conservative management underwent diathermy fissurectomy. After operation patients used a 1 per cent isosorbide dinitrate cream. Postoperative follow-up continued until wounds had healed, at which time anal endosonography was performed. A telephone inquiry into fissure recurrence and continence status was made.
  
  
  RESULTS
  Seventeen patients underwent fissurectomy, without postoperative complications. All wounds had healed within 10 weeks. No fissure recurrence was seen after a median follow-up of 29 months. Histopathology showed non-specific scar tissue without signs of internal anal sphincter fibrosis. Postoperative endosonography showed no evidence of new internal sphincter defects.
  
  
  CONCLUSIONS
  In the treatment of chronic anal fissure not responding to chemical sphincterotomy with nitric oxide donors, fissurectomy in combination with isosorbide dinitrate cream may be a sphincter-sparing surgical technique.
authors.affiliation: Department of Surgery, Ziekenhuis 'de Heel', PO Box 210, 1500 EE Zaandam, The Netherlands. Eng_Eijs@euronet.nl
authors.forename: A F
authors.initials: AF
authors.lastname: Engel
authors.forename: Q A J
authors.initials: QA
authors.lastname: Eijsbouts
authors.forename: A G
authors.initials: AG
authors.lastname: Balk
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D003107:Colorectal Surgery / Q000379:methods; D003131:Combined Modality Therapy; D019160:Endosonography / Q000379:methods; D005260:Female; D005401:Fissure in Ano / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D007548:Isosorbide Dinitrate / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D014665:Vasodilator Agents / Q000627:therapeutic use*; D014945:Wound Healing / Q000187:drug effects
chemical_list: D014665:Vasodilator Agents; D007548:Isosorbide Dinitrate