The Italian Unitary Society of Colon-proctology (SIUCP: Società Italiana Unitaria di Colonproctologia) guidelines for the management of anal fissure.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
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Brillantino Antonio, Renzi Adolfo, Talento Pasquale, Iacobellis Francesca, Brusciano Luigi, Monaco Luigi, Izzo Domenico, Giordano Alfredo, Pinto Michele, Fantini Corrado, Gasparrini Marcello, Schiano Di Visconte Michele, Milazzo Francesca, Ferreri Giovanni, Braini Andrea, Cocozza Umberto, Pezzatini Massimo, Gianfreda Valeria, Di Leo Alberto, Landolfi Vincenzo, Favetta Umberto, Agradi Sergio, Marino Giovanni, Varriale Massimilano, Mongardini Massimo, Pagano Claudio Eduardo Fernando Antonio, Contul Riccardo Brachet, Gallese Nando, Ucchino Giampiero, D'Ambra Michele, Rizzato Roberto, Sarzo Giacomo, Masci Bruno, Da Pozzo Francesca, Ascanelli Simona, Foroni Fabrizio, Palumbo Alessio, Liguori Patrizia, Pezzolla Angela, Marano Luigi, Capomagi Antonio, Cudazzo Eugenio, Babic Francesca, Geremia Carmelo, Bussotti Alessandro, Cicconi Mario, Di Sarno Antonia, Mongardini Federico Maria, Brescia Antonio, Lenisa Leonardo, Mistrangelo Massimiliano, Sotelo Maria Laura Sandoval, Vicenzo Luciano, Longo Antonio, Docimo Ludovico
Аннотация
METHODS: A 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.
CONCLUSIONS: In 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.