2006, Número 1
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Rev Mex Coloproctol 2006; 12 (1)
Fisura anal
Hequera JA, Obregón GJ
Idioma: Español
Referencias bibliográficas: 104
Paginas: 19-32
Archivo PDF: 342.08 Kb.
RESUMEN
La fisura anal es una afección benigna que se caracteriza por el dolor, la localización anal fundamentalmente posterior, la buena respuesta al tratamiento médico en una mayoría y la necesidad de cirugía en la forma crónica.
Objetivo: Se hizo una revisión retrospectiva de la fisura anal para analizar los resultados del tratamiento médico y las indicaciones de las cirugías y sus complicaciones utilizando una casuística personal reciente.
Población y método: Estudio retrospectivo de 60 pacientes tratados en la práctica privada y sanatorial entre enero de 2001 y diciembre del 2005. De ellos, 15 fueron derivados a nuestro grupo para cirugía por fracaso del tratamiento médico. Fueron 32 (53%) mujeres y 28 (47%) hombres. La edad promedio fue 38 años con rango de 27 a 63 años. En 58 (97%) enfermos la fisura fue posterior y en 2 (3%) anterior. En los 45 enfermos se usó pomadas con NTG, baños de asiento calientes con malva y dieta con fibra excluyendo el café, bebidas alcohólicas, frituras, condimentos fuertes, chocolate y tabaco. Se operaron 25 enfermos (15 derivados y 10 por fracaso de NTG). En 18 (72%) se efectuó esfinterotomía lateral interna y en 7 (28%) operación tipo Sarner. En las recidivas se realizaron 2 esfinterotomías y 1 Sarner.
Resultados: De los 45 enfermos tratados con NTG 35 (78%) curaron y hasta el cierre de esta casuística no hay signos de recidiva. En los enfermos en que se realizó ELI hubo 3 con incontinencia transitoria y leve para gases, 4 con cicatrización retardada (2 a 3 meses) y 3 recidivas que se reoperaron con buenos resultados. En los pacientes en que se efectuó operación de Sarner no hubo recidivas (controles entre 3 años y 5 meses).
Discusión: La buena respuesta al tratamiento médico prioriza esta táctica en la fisura anal aguda. La fisura crónica o la falta de respuesta al tratamiento medicamentoso requiere del tratamiento quirúrgico en alguno de los distintos enfoques.
Conclusión: En nuestra experiencia el tratamiento de la fisura anal aguda con NTG fue curativo en cerca del 80% de los pacientes. La cirugía (ELI) fue exitosa en una mayoría y las complicaciones muy escasas, transitorias y leves.
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