Chapter 2 44 ointment for a period of 6 weeks followed by 27% who continued ointment for 12 weeks. Most of the respondents (72%) felt they had enough time to give the patient instructions or advice regarding the use of laxatives, lifestyle, and ointment. Twenty-two percent of the respondents referred to a pelvic floor therapist and they always combined this with fibers and/or laxatives. Botulinum toxin injections were given by 77% of the respondents mainly under general- or spinal anesthesia or sedation (42%). Almost half of the respondents repeated botulinum toxin injections twice and more than 76% never performed botulinum toxin in the levator ani muscle. Fissurectomy was the most popular operative procedure (71%), followed by LIS (27%). More than half of the respondents always, or almost always, used botulinum toxin intersphincteric in case they performed a fissurectomy. When botulinum toxin injections were performed under anesthesia, only 27% performed a fissurectomy simultaneously (Table 1). Follow-up Fifty-seven percent scheduled a physical follow-up check in the outpatient clinic. Forty-three percent referred a patient with CAF to another specialist at least once. A percentage of 57% estimated their patients to be symptom-free after 1 year in 50-75% of the cases. Thirty percent of the respondents had the feeling they always or almost always treat these patients satisfactorily (Table 1). Discussion Implementation of Dutch and international guidelines for chronic anal fissure in daily practice varies. The present study provides an overview of the current approach in management of CAF amongst gastrointestinal surgeons in the Netherlands. The pelvic floor plays a major role in defecation and continence. Furthermore, pelvic floor dysfunctions are prevalent in patients with chronic anal pain syndromes.21,22 However, 28% of the respondents never or almost never asked for any pelvic floor complaints in patients with CAF and only 23% always asked about this topic. Complaints of pelvic floor disorders vary and are often complex, making these disorders less widely recognized.23 A survey by Nicolai et al. about addressing pelvic floor complaints among Dutch gastroenterologists showed that one of the reasons
RkJQdWJsaXNoZXIy MTk4NDMw