Surgical treatment fissures anal
The surgery of the anal crack can be proposed in the event of chronic or complicated crack, or when the pains persist in a way important or repeated in spite of a classical medicamentous treatment.
The medical care of the chronic anal crack, currently made up of nitroglycerin puts cream on topic, of botulinic injection of toxin or the blockers of the calcic channels topics nifédipine or diltiazem, in the acute and chronic crack, and fissures it in the child, can be applied with a chance of cure slightly higher than a placebo.
For the chronic crack in the adult, all the medical care is much less effective than the surgery.
Some of the studied agents most recent seem promising on the basis of single individual study (oil of clove, sildénifil and “cream of care”), but miss comparison with established drugs
Internal side Sphincterotomy
It is about a partial sphinctero-leyomyo-tomy. I.e. a section partial and careful of the smooth muscle of the anus.
Internal section partial sphincter anal. to release diminishes it sphinctérienne,
to decrease the pains at the time of the defecation and to secondarily allow the crack to heal.
rate of repetition < 5%
More than nine times out of ten, the patients operated according to this technique are satisfied
This method exposes to the risk to see appearing signs of incontinence which are usually present once on three immediately after the gesture but which they usually disappear in the weeks which follow.
The sphincterotomy proceeds, under general anaesthesia or under regional anaesthesia loco (rachis anaesthesia during which one deadens only the lower part of the body).
In the event of general anaesthesia, a Pudendal block could be associates. It be-have-to say an injection of calming directly in the sensory nerve of the anus, which will make it possible to relieve the patient the first 12 hours.
The improvement of the painful phenomena occurs rather quickly (a week).
The times of cicatrization are on the other hand longer (five weeks).