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Injection of a sclerosing agent as first line treatment in anal fissure

par Dessily, Michaël ;Charara, Fadi;Chelala, E.;Donfut, A.L.;Alle, Jean-Louis
Référence Acta chirurgica Belgica (Ed. bilingue), 114, 4, page (261-265)
Publication Publié, 2014-01

Article révisé par les pairs

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Résumé :

Background: In our institution, the first line treatment in acute anal fissures (AAF) or chronic anal fissures (CAF) is the injection of a sclerosing agent consisting of phenol, menthol and peanut oil (Phenomen® , Sterop laboratory, Belgium) under the fissure after a local anaesthesia. This retrospective study presents the technique of injection, evaluates its efficacy and demonstrates the minimal occurrence of complications, continence problems and recurrences. Methods: 129 patients with an anal fissure were treated between January 2010 and June 2011. 124 patients were reviewed retrospectively. 109 patients benefited from a sclerosis in our outpatient clinic. Results: Of the 109 patients treated by a sclerosis, 58 had an AAF and 51 had a CAF. 53/58 AAF (91.4%) healed and 40/51 CAF (78.4%). Duration of pain after injection was 2 days or less in 55 cases (50.4%), 1 week or less in 35 cases (32.2%) and more than 1 week in 19 cases (17.4%). The complication rate was low (2.7%): 2 necrosis of the skin and 1 abscess at the site of injection. The rate of troubles of continence was 2.7%: 2 cases of soiling and 1 case of incontinence for gas all resolving within a month. At the end of the study, a fissure had recurred in 17 patients (15.6%). Conclusions: The injection of a sclerosing agent under the fissure is performed in the practitioner's office. Healing rates are high, complications and recurrences are low. This therapeutic option may be a good alternative to classical treatments in case of anal fissures.