T Porrett1, C H Knowles, P J Lunniss. 1. Department of Medical & Surgical Gastroenterology, The Homerton Hospital, Homerton Row, London E9, UK.
Abstract
OBJECTIVE: To create a protocol for colorectal nurse-led management of patients with idiopathic anal fissure. PATIENTS AND METHODS: The outcome of 135 patients with anal fissure presenting over a 3-year period to one (half time equivalent) Colorectal Surgeon in a District General Hospital, in whom initial management was centred on the use of 0.2% glyceryl trinitrate (GTN) was audited. Patients unavailable for complete follow-up, those with fissures of a specific aetiology and those in whom GTN was contra-indicated were excluded. 44% of patients were initially seen by a suitably trained and supported Nurse Practitioner (NP). RESULTS: Success rates for fissure healing with 0.2% GTN were similar to those reported in other studies. There were no differences in outcome between those patients managed by the NP and those managed by the Consultant/Specialist Registrar. As a result of the audit, a treatment protocol for use by Nurse Practitioners (as well as surgical staff), a patient information leaflet, and policy documents relating to NP management of anal fissures have been developed. CONCLUSION: It has been possible to construct a treatment protocol allowing rational management of patients with anal fissure by suitably trained and supported nurse specialists within their own clinic. This may be adapted to encompass future treatment developments.
OBJECTIVE: To create a protocol for colorectal nurse-led management of patients with idiopathic anal fissure. PATIENTS AND METHODS: The outcome of 135 patients with anal fissure presenting over a 3-year period to one (half time equivalent) Colorectal Surgeon in a District General Hospital, in whom initial management was centred on the use of 0.2% glyceryl trinitrate (GTN) was audited. Patients unavailable for complete follow-up, those with fissures of a specific aetiology and those in whom GTN was contra-indicated were excluded. 44% of patients were initially seen by a suitably trained and supported Nurse Practitioner (NP). RESULTS: Success rates for fissure healing with 0.2% GTN were similar to those reported in other studies. There were no differences in outcome between those patients managed by the NP and those managed by the Consultant/Specialist Registrar. As a result of the audit, a treatment protocol for use by Nurse Practitioners (as well as surgical staff), a patient information leaflet, and policy documents relating to NP management of anal fissures have been developed. CONCLUSION: It has been possible to construct a treatment protocol allowing rational management of patients with anal fissure by suitably trained and supported nurse specialists within their own clinic. This may be adapted to encompass future treatment developments.
Authors: Pasquale Giordano; Gianpiero Gravante; Pietro Grondona; Boris Ruggiero; Theresa Porrett; Peter James Lunniss Journal: World J Surg Date: 2009-05 Impact factor: 3.352