Internal Sphincterotomy Is Superior to Topical Nitroglycerin in the Treatment of Chronic Anal Fissure: Results of a Randomized, Controlled Trial by the Canadian Colorectal Surgical Trials Group
Bibliographic record
Abstract
A multicenter randomized, controlled trial compared the effectiveness of topical nitroglycerin (NTG) with lateral internal sphincterotomy (LIS) for the treatment of chronic anal fissure. At 6 months follow-up, 92.1% of the LIS group versus only 27.3% of the NTG group had healed completely ( P = 3 10 –9 ). Twenty of the 44 patients in the NTG group (45.5%) required LIS for persistent symptoms. At 6-year follow-up, LIS patients were less likely to have experienced fissure symptoms within the last year (0 vs. 41%, P = 0.0004), less likely to require subsequent surgical treatment (0 vs. 59%, P > 0.0001), more likely to be “very” or “moderately” satisfied with treatment (100 vs. 56%, P = 0.04), and more likely to choose the same treatment (LIS) again versus topical NTG (92 vs. 63%, P = 0.02). The Fecal Incontinence (FI) score and Fecal Incontinence Quality of Life (FIQL) scale were similar for both groups. LIS provided a more durable cure for chronic anal fissure compared with topical NTG without compromise of long-term fecal continence, resulting in a higher rate of patient satisfaction. Considering the higher cure rate and superior overall patient satisfaction, LIS may appropriately be offered as first-line therapy for patients with chronic anal fissure.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.004 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.003 | 0.003 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".