American journal of surgery · 2007
Internal anal sphincterolysis for chronic anal fissure: a prospective, clinical, and manometric study.
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Gupta Pravin J
Аннотация
BACKGROUND: The author proposes a technique of finger fragmentation of internal anal sphincter fibers to relieve anal sphincter spasm in patients with chronic anal fissures. This prospective study evaluates the clinical and functional outcome in a group of patients with chronic anal fissures.
MATERIALS AND METHODS: Forty-five patients suffering from chronic anal fissure underwent the procedure termed "sphincterolysis." Anal manometry was performed prior to and at 6 and 24 months after treatment. Anal incontinence was evaluated by means of a continence score. Patients were asked to rate the level of satisfaction at the last follow-up.
RESULTS: Forty-four patients completed the study. Symptom control was achieved in 7. 4 +/- 3 days in 91% patients whose fissures had healed when examined 4 weeks after the procedure. In 38 of these patients, pain was relieved at the time of first postoperative defecation. Recurrence of fissure was observed in 1 patient at the 6-month follow-up. Three patients had minor continence disturbances, which resolved within 6 months. Anal manometry before and after the procedure showed a significant reduction in mean resting pressure (MRP) (P < .001), while the maximum squeeze pressure before and after the treatment did not reach a statistically significant reduction. As regards satisfaction grading, 79.5% of patients were highly satisfied with the procedure, while another 16% of patients rated the procedure as good.
CONCLUSION: Internal anal sphincterolysis seems to be an effective, safe and easy procedure, which decreases anal resting pressure and achieves good symptom control with high patient satisfaction.
MATERIALS AND METHODS: Forty-five patients suffering from chronic anal fissure underwent the procedure termed "sphincterolysis." Anal manometry was performed prior to and at 6 and 24 months after treatment. Anal incontinence was evaluated by means of a continence score. Patients were asked to rate the level of satisfaction at the last follow-up.
RESULTS: Forty-four patients completed the study. Symptom control was achieved in 7. 4 +/- 3 days in 91% patients whose fissures had healed when examined 4 weeks after the procedure. In 38 of these patients, pain was relieved at the time of first postoperative defecation. Recurrence of fissure was observed in 1 patient at the 6-month follow-up. Three patients had minor continence disturbances, which resolved within 6 months. Anal manometry before and after the procedure showed a significant reduction in mean resting pressure (MRP) (P < .001), while the maximum squeeze pressure before and after the treatment did not reach a statistically significant reduction. As regards satisfaction grading, 79.5% of patients were highly satisfied with the procedure, while another 16% of patients rated the procedure as good.
CONCLUSION: Internal anal sphincterolysis seems to be an effective, safe and easy procedure, which decreases anal resting pressure and achieves good symptom control with high patient satisfaction.