Resolution of chronic anal fissures after treatment of contiguous internal hemorrhoids with direct current probe.

PURPOSES: (1) to prospectively evaluate efficacy and safety of direct current (DC) probe treatment of chronic anal fissures associated with internal hemorrhoids, and (2) to estimate direct and indirect costs of anoscopic treatment versus surgery.

METHODS: Ten patients with chronic fissures of 11 mm (mean length) had symptoms for 5 months (mean) in spite of medical management; all had internal hemorrhoidal disease. DC coagulation was applied to two or three contiguous internal hemorrhoids per outpatient session. Eleven mA (mean) of DC current was delivered for 7 minutes (mean) per hemorrhoid segment.

RESULTS: All 10 patients had relief of chronic anal pain within two treatments and nine anal fissures healed within 4 weeks. One patient developed a perianal abscess and fistula requiring surgery. There were no recurrences in 20 months (mean) of follow-up with medical management. Mean direct and indirect costs (in terms of lost time from work or usual activity) of DC probe treatments were estimated to be 10% to 30% lower and 2 to 10 times less, respectively, than standard surgery for chronic anal fissures.

CONCLUSION: DC probe treatment for chronic anal fissures associated with internal hemorrhoidal disease is an important advance as an effective, safe, and cost-effective nonsurgical treatment in selected patients.