The Italian Unitary Society of Colon-proctology (SIUCP: Società Italiana Unitaria di Colonproctologia) guidelines for the management of anal fissure

BMC Surgery

Research

Luigi Marano¹  Fabrizio Foroni²  Luciano Vicenzo²  Alessio Palumbo²  Maria Laura Sandoval Sotelo²  Antonio Brillantino²  Ludovico Docimo³  Luigi Brusciano³  Federico Maria Mongardini³  Andrea Braini⁴  Michele Schiano Di Visconte⁵  Roberto Rizzato⁶  Giacomo Sarzo⁷  Umberto Cocozza⁸  Giovanni Marino⁹  Mario Cicconi^1,10  Francesca Iacobellis^1,11  Domenico Izzo^1,12  Alfredo Giordano^1,13  Massimilano Varriale^1,14  Alberto Di Leo^1,15  Michele D’Ambra^1,16  Vincenzo Landolfi^1,17  Antonio Brescia^1,18  Francesca Babic^1,19  Leonardo Lenisa^2,20  Eugenio Cudazzo^2,21  Giovanni Ferreri^2,21  Francesca Milazzo^2,21  Pasquale Talento^2,21  Angela Pezzolla^2,22  Simona Ascanelli^2,23  Corrado Fantini^2,24  Massimiliano Mistrangelo^2,25  Patrizia Liguori^2,26  Francesca Da Pozzo^2,27  Riccardo Brachet Contul^2,28  Michele Pinto^2,29  Sergio Agradi^3,30  Marcello Gasparrini^3,31  Valeria Gianfreda^3,32  Giampiero Ucchino^3,33  Nando Gallese^3,34  Carmelo Geremia^3,35  Umberto Favetta^3,35  Claudio Eduardo Fernando Antonio Pagano^3,35  Antonia Di Sarno^3,36  Adolfo Renzi^3,36  Massimo Pezzatini^3,37  Massimo Mongardini^3,38  Antonio Longo^3,39  Antonio Capomagi^4,40  Luigi Monaco^4,41  Alessandro Bussotti^4,42  Bruno Masci^4,43 

[1] Academy of Applied Medical and Social Sciences - AMiSNS: Akademia Medycznych i Spolecznych Nauk Stosowanych, Elbląg, Poland;Deparment of Surgery, “A. Cardarelli” Hospital, Via A. Cardarelli 9, 80131, Naples, Italy;Department of Advanced Medical and Surgical Sciences, University of Campania “L. Vanvitelli”, Naples, Italy;Department of General Surgery, Azienda Sanitaria Friuli Occidentale (ASFO), Pordenone, Italy;Department of General Surgery, Colorectal and Pelvic Floor Diseases Center, “Santa Maria Dei Battuti” Hospital, Conegliano, TV, Italy;Department of General Surgery, Hospital of Conegliano AULSS 2, Marca Trevigiana, Treviso, Italy;Department of General Surgery, University of Padova, “Sant’Antonio” Hospital, Padova, Italy;Department of General Surgery, “S. Maria Degli Angeli” Hospital, Putignano (Bari), Italy;Department of General Surgery, “Santa Marta e Santa Venera” Hospital of Acireale, Catania, Italy;Department of General Surgery, “Sant’Omero-Val Vibrata” Hospital, Teramo, Italy;Department of General and Emergency Radiology, “A. Cardarelli” Hospital, Naples, Italy;Department of General and Emergency Surgery, AORN dei Colli Monaldi-Cotugno-CTO, CTO Hospital, Naples, Italy;Department of General and Emergency Surgery, University of Salerno, Hospital of Mercato San Severino, Salerno, Italy;Department of General and Emergency Surgery, “Sandro Pertini” Hospital, Asl Roma 2, Rome, Italy;Department of General and Minivasive Surgery, “San Camillo” Hospital, Trento, Italy;Department of General and Oncologic-Minivasive Surgery, “Federico II” University, Naples, Italy;Department of General and Specalist Surgery, AORN “S.G. Moscati”, Avellino, Italy;Department of Oncologic Colorectal Surgery, University Hospital S. Andrea, “La Sapienza” University, Rome, Italy;Department of Surgery, Hospital of Cattinara, ASUGI Trieste, Trieste, Italy;Department of Surgery, Humanitas San Pio X, Surgery Unit, Pelvic Floor Centre, Milano, Italy;Department of Surgery, Pelvic Floor Center, AUSL-IRCCS Reggio Emilia, Reggio Emilia, Italy;Department of Surgery, University Aldo Moro, Bari, Italy;Department of Surgery, University Hospital of Ferrara, Ferrara, Italy;Department of Surgery, “Dei Pellegrini” Hospital, ASL Napoli 1, Naples, Italy;Department of Surgery, “Le Molinette” Hospital, Torino, Italy;Department of Surgery, “Mater Dei” Hospital, Bari, Italy;Department of Surgery, “Santa Maria dei battuti” Hospital, San Vito al Tagliamento, Pordenone, Italy;General Ad Urgent Surgery, “U. Parini” Regional Hospital, Aosta Valley, Italy;Humanitas Castelli, Bergamo, Italy;Humanitas Gavazzeni/Castelli Bergamo, Bergamo, Italy;Oncologic Colorectal Unit, “Sant’Andrea” University Hospital, Rome, Italy;Unit of Colonproctologic and Pelvic Surgery, “M.G. Vannini” Hospital, Rome, Italy;Unit of General Surgery, “Maggiore” Hospital, Bologna, Italy;Unit of Proctologic Surgery, “Sant’Antonio” Clinic, Cagliari, Italy;Unit of Proctology and Pelvic Surgery, “Città di Pavia” Clinic, Pavia, Italy;“Buonconsiglio-Fatebenefratelli” Hospital, Naples, Italy;“Dei Castelli” Hospital, ASL Roma 6, Rome, Italy;“La Sapienza” University of Rome, “Umberto1” Polyclinic, Rome, Italy;“Madonna Della Fiducia” Clinic, Rome, Italy;“Montanari” Hospital, Morciano di Romagna, Rimini, Italy;“Pineta Grande” Hospital, “Villa Esther” Clinic, Avellino, Italy;“San Carlo Di Nancy” Hospital, Rome, Italy;“San Carlo di Nancy” Hospital, Rome, Italy;

关键词: Anal fissure;    Anal spasm;    Endoanal ultrasound;    Anal manometry;    Anal dilatation;    Sphincterotomy;    Fissurectomy;    SIUCP;   

DOI  :  10.1186/s12893-023-02223-z

 received in 2023-05-04, accepted in 2023-10-06,  发布年份 2023

来源: Springer

【 摘 要 】

IntroductionThe aim of these evidence-based guidelines is to present a consensus position from members of the Italian Unitary Society of Colon-Proctology (SIUCP: Società Italiana Unitaria di Colon-Proctologia) on the diagnosis and management of anal fissure, with the purpose to guide every physician in the choice of the best treatment option, according with the available literature.MethodsA panel of experts was designed and charged by the Board of the SIUCP to develop key-questions on the main topics covering the management of anal fissure and to performe an accurate search on each topic in different databanks, in order to provide evidence-based answers to the questions and to summarize them in statements. All the clinical questions were discussed by the expert panel in different rounds through the Delphi approach and, for each statement, a consensus among the experts was reached. The questions were created according to the PICO criteria, and the statements developed adopting the GRADE methodology.ConclusionsIn patients with acute anal fissure the medical therapy with dietary and behavioral norms is indicated. In the chronic phase of disease, the conservative treatment with topical 0.3% nifedipine plus 1.5% lidocaine or nitrates may represent the first-line therapy, eventually associated with ointments with film-forming, anti-inflammatory and healing properties such as Propionibacterium extract gel. In case of first-line treatment failure, the surgical strategy (internal sphincterotomy or fissurectomy with flap), may be guided by the clinical findings, eventually supported by endoanal ultrasound and anal manometry.

【 授权许可】

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© BioMed Central Ltd., part of Springer Nature 2023