Assistant Professor of Colorectal Surgery, Colorectal Research Center, Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran.
Colorectal Research Center, Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran.
Int J Surg. 2022 Jun;102:106661. doi: 10.1016/j.ijsu.2022.106661. Epub 2022 May 11.
Anal fissure is a linear tear in the distal anoderm most frequently occurring in the posterior midline. Lateral internal sphincterotomy is considered the gold standard for the treatment of this condition. To this date, several pharmacological and neuromodulatory therapies have been tried out as alternative non-invasive treatments for anal fissures, however, the efficacy of some of these methods remains to be understood.
the primary aim of this study was to review available literature on neuromodulatory treatments for recurrent anal fissure as a potentially effective cure for this condition.
A search was conducted among five main online databases Embase, PubMed, Web of Science, Scopus, and Scholar.
All published human studies in English literature addressing neuromodulation for the treatment of recurrent anal fissure were selected.
neuromodulation for the treatment of anal fissure. We chose to include all articles in which the authors stated that the procedure they performed was via neuromodulation technique, or that the described technique used in their study resembled the technique.
Among a total of 3487 evaluated studies, seven represented the effects of neuro modulation on treatment of recurrent anal fissure, among which two were randomized controlled trials and the rest were prospective studies. A total of 186 patient were evaluated in these studies. The mean age of the participants was 46.97 ± 8.2. The average VAS score before intervention was 7.77 ± 2.13, which decreased to 0.31 ± 1.13 after intervention.
limitations of this study include the lack of related articles, and data regarding this subject.
Posterior tibial nerve stimulation (PTNS) provides rapid pain relief and fissure healing especially in short-to mid-terms with little to no complications, however, using this treatment, symptoms of anal fissure do not improve as well as LIS, especially in the long-term.
肛裂是最常发生于后正中线的远端肛门内括约肌处的线性撕裂。外侧内括约肌切开术被认为是治疗这种疾病的金标准。迄今为止，已经尝试了几种药理学和神经调节治疗作为肛裂的替代非侵入性治疗方法，然而，其中一些方法的疗效仍有待了解。
本研究的主要目的是回顾关于神经调节治疗复发性肛裂的文献，以评估其作为这种疾病的潜在有效治疗方法的效果。
在 Embase、PubMed、Web of Science、Scopus 和 Scholar 这五个主要在线数据库中进行了搜索。
选择了所有发表于英文文献中关于神经调节治疗复发性肛裂的研究。
用于治疗肛裂的神经调节。我们选择了所有在文章中提到他们所进行的手术是通过神经调节技术，或描述的技术与他们研究中使用的技术相似的文章。
在总共 3487 项评估研究中，有 7 项研究代表了神经调节对复发性肛裂治疗的效果，其中 2 项为随机对照试验，其余为前瞻性研究。这些研究共评估了 186 名患者。参与者的平均年龄为 46.97±8.2 岁。干预前的平均 VAS 评分为 7.77±2.13，干预后降至 0.31±1.13。
本研究的局限性包括相关文章和该主题的数据的缺乏。
胫后神经刺激（PTNS）可迅速缓解疼痛并促进肛裂愈合，尤其是在短期至中期，并发症很少，但与 LIS 相比，使用这种治疗方法，肛裂的症状改善并不明显，尤其是在长期。
