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J Pediatr 2020 Jul;222:207-212

Department of Pediatric Surgery, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam and VU Amsterdam, Amsterdam, The Netherlands.

Objective: To review the Anorectal Malformation Network experience with perineal groove (PG) focusing on its clinical characteristics and management.

Study Design: Data on patients with PG managed at 10 participating Anorectal Malformation Network centers in 1999-2019 were collected retrospectively by questionnaire.

Results: The cohort included 66 patients (65 females) of median age 1. Read More

Colorectal Dis 2020 Jun 13. Epub 2020 Jun 13.

Section of Colorectal Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada.

Aim: The aim of this study is to report changes in health-related quality of life attributable to lateral internal sphincterotomy for treatment of anal fissure. There is very little evidence on whether the overall health-related quality of life of patients is detrimentally affected by the condition, or which aspects of self-perceived health status improve after lateral internal sphincterotomy. This study will articulate which aspects of health tend to improve and guide postoperative expectations appropriately. Read More

J Family Med Prim Care 2020 Mar 26;9(3):1562-1566. Epub 2020 Mar 26.

Department of Medicine, School of Medicine, Semnan University of Medical Sciences, Semnan, Iran.

Background: One of the most frequent distressing diseases which causes anal pain and bleeding after defecation is anal fissure. Despite a poorly understood pathogenesis, the internal anal sphincter spasm has been identified to play a central role in pathogenesis. Recently, botulinum toxin is being used increasingly for the treatment of chronic anal fissure to achieve chemical sphincterotomy and reduce internal sphincter tonicity. Read More

Headache 2020 Jun 3. Epub 2020 Jun 3.

Service of Neurology, University Hospital Marqués de Valdecilla, IDIVAL and University of Cantabria, Santander, Spain.

Many patients with chronic migraine are difficult to treat. We present a patient with chronic migraine with good response to onabotulinum toxin type A whose headaches worsened in clear temporal relationship to local treatment with glyceryl trinitrate for an anal fissure. Our case shows that the use, even at distance, of nitric oxide donors can be a precipitating factor for migraineurs and should be always inquired in chronic migraine patients. Read More

Tech Coloproctol 2020 07 31;24(7):785. Epub 2020 May 31.

Indus International Hospital, Mohali, Punjab, India.

Turk J Gastroenterol 2020 Apr;31(4):289-294

Department of General Surgery, Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey.

Background/aims: An anal fissure (AF) is a linear tear in the distal anal canal and is one of the most common causes of anal pain. Hemorrhoidal disease (HD) is a symptomatic growth and distal displacement of normal anal cushions. Numerous studies have addressed the contributing factors of these conditions, yet the results remain controversial. Read More

Mo Med 2020 Mar-Apr;117(2):154-158

Rakesh Hegde, MD, John M. Trombold, MD & José M. Dominguez, MD, MSMA member since 1996, are in the Department of Colon and Rectal Surgery, Ferrell-Duncan Clinic, CoxHealth, Springfield, Missouri.

Anorectal conditions are one of the most common problems evaluated by primary care physicians. Most patients present with rectal pain, rectal bleeding, or purulent drainage per rectum. Colorectal conditions have overlapping symptoms. Read More

BMC Res Notes 2020 Apr 16;13(1):214. Epub 2020 Apr 16.

Department of Surgery, Faculty of Medicine, University of Colombo, P.O. Box 271, Kynsey Road, Colombo 8, Western Province, Sri Lanka.

Objective: Flexible sigmoidoscopy is useful to look for an underlying aetiology in fistula-in-ano. This study was aimed to assess the yield of routine flexible sigmoidoscopy in patients presenting with fistula-in-ano. A retrospective analysis of 159 consecutive patients with fistula-in-ano who underwent routine flexible sigmoidoscopy was performed. Read More

Niger J Clin Pract 2020 Apr;23(4):539-544

Department of General Surgery, Atatürk Training and Research Hospital, İzmir Katip Çelebi University, Çigli, İzmir, Turkey.

Background: Anal fissure which is defined as a longitudinal tear in anoderm below the dentate line is one of the most common benign diseases of anorectal area. Severe pain during the defecation and emotional stress that it causes may reduce people's quality of life.

Aims: In this randomized clinical trial, we aimed to compare the efficiency of the topical ointment with medical treatment and surgical lateral internal sphincterotomy. Read More

Rev Prat 2019 Nov;69(9):1005-1010

Service de proctologie médico-chirurgicale, groupe hospitalier Paris-Saint-Joseph, Paris, France.

Anal fissure. Anal fissure is a painful proctological disease that most often affects young patients equally in both sexes. It significantly worsens the quality of life and requires rapid care. Read More

Tech Coloproctol 2020 06 31;24(6):611-612. Epub 2020 Mar 31.

Division of Colorectal Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.

Prague Med Rep 2020 ;121(1):25-34

Department of Gastroenterology, Desun Hospital and Heart Institute, Kolkata, India.

Incidence of lower gastrointestinal (GI) bleeding (LGIB) is increasing over time. It can be seen in all age group patients, commonly associated with pre-existing comorbidities and is one of the common indications of colonoscopy. This study was done to identify common causes of LGIB in eastern part of India, because there is no previous study from Eastern India to identify the common causes of lower GI bleeding diagnosed by colonoscopy in different age group patients. Read More

Ann Coloproctol 2020 Mar 16. Epub 2020 Mar 16.

Unit of Colorectal Surgery, Soroka University Mediacal Center, Beer Sheva, Israel.

Purpose: For the past several decades, internal anal sphincterotomy has generally been considered to be the standard operation for an anal fissure. However, wound complications inherent in this operation forced surgeons to look for an alternative form of treatment. The aim of our study was to evaluate the long term outcome of anal dilatation for chronic anal fissure, especially possible negative impact on anal sphincter function. Read More

Ann Coloproctol 2020 Apr 17;36(2):122-127. Epub 2020 Mar 17.

Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia.

The ideal intervention in the treatment of perianal fistula prevents the onset of infection to speed healing and prevent fistula recurrence while maintaining the function of the anal sphincter. Currently, there is no consensus on the best recommended surgical technique for perianal fistula management. Several studies have shown that fistulotomy was an easy and safe procedure for treatment of perianal fistula. Read More

Ann Ital Chir 2020 Jan 31;9. Epub 2020 Jan 31.

Introduction: Although lateral internal sphincterotomy (LIS) is the most preferred surgical treatment for chronic anal fissure, In this study, we aimed to investigate the effect of preoperative anorectal manometry on surgical treatment choice in patients presenting with anal fissure.

Material And Methods: Between January-2015 and August-2017 and whose physical examination revealed chronic anal fissure findings were included in the study. Patients were divided into two groups as Group 1 LIS and Group 2 non-LIS. Read More

Dis Colon Rectum 2020 Jun;63(6):831-836

Department of Surgery, Bursa Medicana Hospital, Bursa, Turkey.

Background: Ablation of anal fistula tract using a radial laser-emitting probe is a sphincter-preserving technique.

Objective: The purpose of this study was to assess long-term outcomes of laser ablation of fistula tract.

Design: This was a retrospective analysis of the long-term outcomes of 100 patients who underwent laser ablation of fistula tract. Read More

Int J Surg 2020 04 25;76:93. Epub 2020 Feb 25.

East Suffolk and North Essex NHS Foundation Trust, UK.

Int J Surg 2020 04 25;76:120. Epub 2020 Feb 25.

Formerly General Surgeon at the Kent and Sussex Hospital in Tunbridge Wells, Kent, UK. Electronic address:

J Neonatal Perinatal Med 2020 Feb 21. Epub 2020 Feb 21.

McMaster Pediatric Surgery Research Collaborative.

Background: Glycerin suppositories are often used to facilitate meconium evacuation in premature infants. The evidence for this practice is inconclusive. The purpose of this study was to assess the feasibility of a multicenter randomized controlled trial on the effectiveness of this treatment strategy. Read More

Hautarzt 2020 Apr;71(4):269-274

EDZ Mannheim, Bismarckplatz 1, 68165, Mannheim, Deutschland.

Hemorrhoidal disease is one of the most common illnesses in industrialized nations. Up to 70% of adults suffer from the disease once in their lifetime. This underlines the necessity and importance of knowing about the differential diagnosis of hemorrhoids. Read More

J Pediatr Surg 2020 Jan 30. Epub 2020 Jan 30.

Pediatric Surgery Division, Department of Surgery, King Saud University Medical City, College of Medicine, King Saud University, Riyadh, Saudi Arabia.

Background: Anal fissure (AF) in children is usually treated with laxatives and/or topical agents such as calcium channel blockers. We hypothesize that owing to the superior efficacy of Polyethylene glycol (PEG) in treating constipation in children, adding diltiazem (DTZ) might not improve healing of AF.

Methods: Children ≤14 years with anal fissure presented to the pediatric surgery clinic between November 2014 and March 2016 were recruited. Read More

Am J Surg 2020 03 7;219(3):445. Epub 2019 Nov 7.

Int J Surg 2020 Mar 4;75:152-158. Epub 2020 Feb 4.

Colorectal Surgery Unit, Department of General Surgery, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt. Electronic address:

Background: Chronic anal fissure (CAF) is a common painful anal condition. Medical treatment of CAF involves the use of agents that induce chemical sphincterotomy. The present trial aimed to compare the efficacy and safety of topical minoxidil and glyceryl trinitrate (GTN) preparations in treatment of CAF. Read More

Int J Colorectal Dis 2020 Apr 24;35(4):615-621. Epub 2020 Jan 24.

Digestive Disease Center K, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400, Copenhagen NV, Denmark.

Purpose: To compare the standard treatment, diltiazem gel 2%, with Levorag® Emulgel for chronic anal fissures.

Methods: This was a single-blinded, randomised, controlled, clinical trial with a non-inferiority design. Patients with a chronic anal fissure were randomised to treatment with diltiazem or Levorag® Emulgel twice daily for 8 weeks. Read More

Am J Gastroenterol 2020 03;115(3):315-316

Department of Medicine, Baylor College of Medicine and VAMC, Houston, Texas, USA.

Ann Dermatol Venereol 2020 Feb 16;147(2):127-130. Epub 2020 Jan 16.

Service de dermatologie-infectiologie, CHI de Fréjus/Saint-Raphaël, 240, avenue Saint-Lambert, 83608 Fréjus, France; Service de dermatologie, hôpital Archet 2, CHU de Nice, 151, route St-Antoine-de-Ginestiere, 06202 Nice, France.

Introduction: Syphilis mainly affects men who have sex with men (MSM) between the ages of 20 and 49. Herein we report a case in a teenager illustrating extension of the epidemic to other populations.

Patients And Methods: A 15-year-old boy consulted in May 2018 for an anal fissure and painful oral erosions. Read More

Curr Drug Deliv 2020 ;17(2):126-139

Department of Pharmaceutical Technology, Faculty of Pharmacy, Ankara University, 06100 Tandogan, Ankara, Turkey.

Objective: Current study focuses on the formulation and characterization of lipophilic and hydrophilic gel formulations of nifedipine to treat anal fissure via anodermal application.

Methods: Lipophilic gels were prepared with Aerosil grades as gelling agents in bulk oils. Polyethylene glycols, hydroxypropyl methylcellulose, and Carbopol® 974P were used as gelling agents in water and propylene glycol for forming hydrophilic gels. Read More

Colorectal Dis 2020 May 12;22(5):593-594. Epub 2020 Jan 12.

Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.

Hemoglobin 2019 Jul - Sep;43(4-5):296-299. Epub 2019 Nov 14.

Department of Internal Medicine, La Timone Hospital, Marseille, France.

Patients with sickle cell disease have an increased risk of venous thromboembolism (VTE) and with a mortality 2-fold higher. The anticoagulation of VTE in a young population is an important question. Indeed, hemorrhagic complications of anticoagulation may occur more frequently than in the general population. Read More

Endosc Int Open 2019 Nov 11;7(11):E1549-E1562. Epub 2019 Nov 11.

Department of Gastroenterology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.

 Anal examination and video anoscopy (VA) are rarely performed during colonoscopies. The aim of this study is to demonstrate that anal examination and VA provide important information in all routine colonoscopies.  A cross-sectional study was conducted on 12,151 patients screened by VA which were performed during routine outpatient colonoscopy between 2006 and 2018. Read More

Curr Opin Gastroenterol 2020 Jan;36(1):19-24

Division of Gastroentrology, Dept of Medicine, Baylor College of Medicine, Houston, Texas, USA.

Purpose Of Review: Anal fissures are very common. They are easy to diagnose and treat in the office setting. They may coexist with hemorrhoids. Read More

Am J Surg 2020 03 11;219(3):442-444. Epub 2019 Oct 11.

Spectrum Health, 4100 Lake Dr, Suite 201, United States. Electronic address:

Background: Botulinum toxin has been established as a non-surgical alternative for chronic anal fissures. There is a paucity of data regarding which patients benefit most from this intervention.

Methods: We retrospectively collected data from all cases of chronic anal fissures treated with botulinum toxin over seven years to identify predictors of success. Read More

J Invest Surg 2019 Oct 18:1-6. Epub 2019 Oct 18.

Proctology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS , Rome , Italy.

Anorectal function of inflammatory bowel disease (IBD) patients is still poorly understood, with contradictory results. This prospective observational study aimed to analyze the effect of perianal disease on anorectal function and quality of life in IBD patients. Patient assessment included full clinical examination, validated scores, anorectal manometry, three-dimensional endoanal ultrasonography, and endoscopy. Read More

Indian J Pathol Microbiol 2019 Oct-Dec;62(4):645-646

Department of Surgery, Lady Hardinge Medical College, New Delhi, India.

Dis Colon Rectum 2019 11;62(11):1390-1400

Indian Council of Medical Research, New Delhi, India.

Background: Few data are published on perianal tuberculosis.

Objective: This study aimed to determine the best method to diagnose tuberculosis in patients with fistula-in-ano and to conduct a systematic review to determine the incidence and characteristics of tuberculosis fistula-in-ano.

Data Sources: The prospective study data and existing literature were derived from PubMed, Google scholar, and Scopus STUDY SELECTION:: Prospective analysis of patients with tuberculous fistula-in-ano treated between 2014 and 2018 was conducted, and a systematic review of studies describing ≥3 patients with tuberculosis fistula-in-ano was completed. Read More

Tech Coloproctol 2019 Oct 24;23(10):1009-1013. Epub 2019 Sep 24.

Department of Gastroenterological Surgery, Kameda Medical Center, 929 Higashi-cho, Kamogawa City, Chiba, 296-8602, Japan.

Clin Colon Rectal Surg 2019 Sep 6;32(5):377-385. Epub 2019 Sep 6.

Division of Colorectal Surgery, Hospital Santa Helena Los Álamos, Málaga, Spain.

This article provides an overview of the principles in the evaluation and management of perianal Crohn's disease (CD). Manifestation-specific treatment is addressed including abscess, fistula, skin tags, hemorrhoids, fissure, ulcers, strictures, ano-, and rectovaginal fistulas as well CD-associated hidradenitis suppurativa. Read More

Khirurgiia (Mosk) 2019 (8. Vyp. 2):32-39

Rostov State Medical University, Health Ministry of the Russian Federation, Rostov-on-Don, Russian Federation.

Aim: To objectify the criteria for choosing the method of treatment of anal fissures, to determine the indications for surgery and sphincterotomy.

Material And Methods: The results of treatment of 206 patients with chronic and acute anal fissures between the ages of 17 to 75 years are analyzed. The posterior anal fissure was detected in 175 (84. Read More

Khirurgiia (Mosk) 2019 (8. Vyp. 2):24-31

Ryazan State Medical University im. A.I. Pavlova, Ryazan, Russia.

The problem of the treatment of pilonidal disease, affecting 5% of the adult working-age population and occupying the fourth place in the structure of coloproctological diseases after hemorrhoids, paraproctitis and anal fissure, is extremely relevant today. The history of the choice of approaches to surgical treatment has almost 2 centuries. Based on different theories of etiopathogenesis, various methods of surgical treatment have been proposed. Read More

Rev Col Bras Cir 2019 Aug 15;46(3):e20192181. Epub 2019 Aug 15.

Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Cirurgia do Aparelho Digestivo e Coloproctologia, São Paulo, SP, Brasil.

Objective: to evaluate the long-term results of the correction of chronic anal fissures (CAF) in patients without anal hypertonia using the technique of anoplasty with skin tag flap.

Methods: we conducted a prospective study of CAF patients refractory to conservative treatment without anal hypertonia, subjected to anoplasty with the use of anal plicoma to cover the bloody area. We confirmed the absence of anal hypertonia through rectal exam and electromanometry. Read More

Br J Gen Pract 2019 Aug;69(685):409-410

Colorectal Surgery, NHS Lothian, Edinburgh.

Rev Esp Enferm Dig 2019 Sep;111(9):672-676

Servicio de Cirugía General y Aparato Digestivo, Hospital de Jove, España.

Introduction: pharmacological treatment of a chronic anal fissure (CAF) achieves healing in half of cases and lateral internal sphincterotomy (LIS) is the definite treatment. The objective of this study was to assess the combination of fissurectomy and botulin toxin A (BTA) injection.

Methods: this was a retrospective study of 54 patients with anal sphincter hypertonia and CAF treated with an injection of BAT and fissurectomy, after an unsuccessful management with topical nitroglycerin (NGT) for eight weeks. Read More

Clin Colon Rectal Surg 2019 Jul 2;32(4):255-260. Epub 2019 Jul 2.

Department of Colorectal Surgery, Cleveland Clinic, Cleveland, Ohio.

Perianal symptoms occur in up to 50% of patients with Crohn's disease in other parts of the gastrointestinal tract, and in 5% of patients it is the first manifestation of the disease. The perianal area is often under stress in patients with Crohn's disease, because of the diarrhea, and the fecal urgency, frequency, and incontinence caused by proximal disease. Symptomatic perianal disease can therefore be due to the effects of the stress on an otherwise normal anus, or the result of Crohn's disease in the low rectum and/or perianal tissues themselves. Read More

CMAJ 2019 07;191(26):E737

Department of Surgery, Foothills Medical Centre, Calgary, Alta.

ANZ J Surg 2019 07 1;89(7-8):E288-E291. Epub 2019 Jul 1.

Colorectal Unit, Department of Surgery, Michallon University Hospital, Grenoble, France.

Background: Some authors, either with anatomical studies or Doppler laser flowmetric investigations have shown the blood flow to the posterior midline of the anus to be potentially deficient. This relative local ischaemia might explain pathogenesis of anal fissure, which is often located posteriorly. The aim of this study was to record the exact position of the distal branches of the superior rectal artery during Doppler-guided haemorrhoidal artery ligation-rectoanal repair (HAL-RAR) procedures with special reference to posterior distribution of the arteries. Read More

Dis Colon Rectum 2019 07;62(7):867-871

Division of Colorectal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio.

Background: A large proportion of patients with anorectal complaints are referred to colorectal surgeons with the label of hemorrhoids.

Objective: The purpose of this study was to review presenting symptoms and frequency of accurate diagnosis, as well as to analyze determinants of misdiagnosis to guide educational endeavors.

Design: This was a retrospective study. Read More

J Cell Biochem 2019 10 30;120(10):17098-17107. Epub 2019 May 30.

Departments of Dermatology, Second Affiliated Hospital of Shandong First Medical University, Taian, Shandong, China.

Background: Anal abscess is an important complication of anal fissure (AF), whereas interleukin-6R (IL-6R) has been implicated in the development of abscess. In this study, we aimed to explore the possible molecular mechanisms underlying the regulatory effects of miRNAs on IL-6R and other inflammatory factors related to the induction of anal abscess in AF.

Methods: Bioinformatics analysis, luciferase assay, real-time polymerase chain reaction, and Western blot analysis were performed to identify the possible regulatory relationships between IL-6R and miR-124/miR-125a by comparing the differentiated expression of miR-125a, miR-124, tumor necrosis factor-α (TNF-α), interferon-γ (IFN-γ), and IL-4 among different groups of AF patients. Read More

BMC Cancer 2019 Apr 23;19(1):374. Epub 2019 Apr 23.

Department of Urology, National Cancer Institute, 1 Santariskiu Str., LT-08406, Vilnius, Lithuania.

Background: Here we present the first cases of prostate cancer solitary metastasis to anal canal.

Case Presentation: A 67-year-old male patient underwent radical prostatectomy with ilio-obturator lymphonodectomy in 2016 due to poorly differentiated ductal adenocarcinoma (Gleason 4 + 5(40%) = 9) pT3bN0. Two months later increasing PSA rate was noted and the patient started adjuvant intermittent androgen deprivation therapy combined with radiotherapy. Read More

Rev Prat 2019 Jan;69(1):67-70

Maison de santé protestante de Bordeaux-Bagatelle, Talence, France.

Main traps in proctology. Traps are numerous in proctology. Avoiding the clinical examination is the most common. Read More