Treatment of chronic anal fissure using subcutaneous lateral internal sphincterotomy
Abstract
Retrospective analysis of 113 patients with chronic anal fissure treated surgically at the Department of Surgery, University Hospital Dubrava in a 10-year period from 1994 to 2003. Average patient age was 44 years, and there were 53% men and 47% women. The diagnosis was established using proctologic examination that included rectoscopy. Most common localization of the fissure was in the posterior anal commissure (90%) and much more seldom in the front commissure (10%). Average duration of symptoms was 14 months (6-20 months). Of 113 patients, 32 (28%) of them have been previously ineffectively treated with other methods in other centers (sclerosation and laser photocoagulation, anal dilataion, excision of the fissure). Patients were operated using the method of subcutaneous lateral internal sphincterotomy (SLIS). Control group comprised of 30 patients, conservatively treated with local application of 0.2% isosorbid-dinitrate ointment. At first control examination 95% of patients declared clearance of pain during defecation. At one month after surgery fissure healed in 107 (95%) patients. Among conservatively treated patients, fissure healed in 13% after one month and in 30% after 3 months (p<0.001). Four patients (3.5%) had recurrence. Treatment-related post-operative complications were seen in 3 (2.6%) patients, two perianal abscesses and one perianal fistula. Incontinence for flatus was observed in 10 (8.8%) patients and faecal soiling in 5 (4.4%) patients. Authors conclude that based on these results and those from the literature SLIS represents a very successful and safe method for treating chronic anal fissure.> <0.001). Four patients (3.5%) had recurrence. Treatment-related post-operative complications were seen in 3 (2.6%) patients, two perianal abscesses and one perianal fistula. Incontinence for flatus was observed in 10 (8.8%) patients and faecal soiling in 5 (4.4%) patients. Authors conclude that based on these results and those from the literature SLIS represents a very successful and safe method for treating chronic anal fissure.
Downloads
References
Abcarian H. Surgical correction of chronic anal fissure: results of lateral internal sphincterotomy vs. fissurectomy-midline sphincterotomy. Dis Colon Rectum 1980; 23:31-6.
Bennett RC, Duthie HL. The Functional Importance of the lnternal Anal Sphincter. Br J Surg 1964; 51:355-7.
Bennett RC, Goligher JC. Results of internal sphincterotomy for anal fissure. Br Med J 1962; 5318:1500-3.
Duthie HL, Bennett RC. Anal Sphincteric Pressure in Fissure in Ano. Surg Gynecol Obstet 1964; 119:19-21.
Eisenhammer S. The evaluation of the internal anal sphincterotomy operation with special reference to anal fissure. Surg Gynecol Obstet 1959: 109:583-90.
Fischer M. Thermann M, Hamelmann H. Manometric studies of the anal canal in chronic primary fissure before and after management using dilalation of sphincterotomy. Chirurg 1978; 49: 111-3.
Gibbons CP, Read NW. Anal hypertonia in fissures: cause or effect? Br J Surg 1986; 73:443-5.
Goligher JC, Leacock AG, Brossy JJ. The surgical anatomy of the anal canal. Br J Surg 1955; 43:51-61.
Goligher JC. Anal fissure. Surgery of the anus, rectum and colon. London: Bailliere Tindal; 1988; 150-66.
Hancock BO. Measurement of anal pressure and motility. Gut 1976; 17:645-51.
Hancock BO. The internal sphincter and anal fissure. Br J Surg 1997; 64:92-5.
Hiltunen KM, Matikainen M. Anal manometric evaluation in anal fissure. Effect of anal dilation and lateral subcutaneous sphincterotomy. Acta Chir Scand 1986; 152:65-8.
Hoffmann DC, Goligher JC. Lateral subcutaneous internal sphincterotomy in treatment of anal fissure. Br Med J 1970; 3:673-5.
Hsu TC, MacKeigan JM. Surgical treatment of chronic anal fissure. A retrospective study of 1753 cases. Dis Colon Rectum 1984; 27:475-8.
Kuypers HC. Is there really sphincter spasm in anal fissure? Dis Colon Rectum 1983; 26:493-4.
Lewis TH, Corman ML, Prager ED, Robertson WG. Long-term results of open and closed sphincterotomy for anal fissure. Dis Colon Rectum 1988; 31:368-71.
Lockert-Mummeri HE. Fissure in ano. Rob C, Smith R. ur. Operative surgery. ed. 3. London: Butterworths; 1957; 11.
McNamara MJ, Percy JP, Fielding IR. A manometric study of anal fissure treated by subcutaneous lateral internal sphincterotomy. Ann Surg 1990; 211 :235-8.
Melange M. Colin JF, Van Wymersch T. Vanheuverzwyn R. Anal fissure: correlation between symptoms and manometry before and after surgery. Int J Colorectal Dis 1992; 7:108-11.
Nicholls RJ, Glass RE. Anal disease. Coloproctology: diagnosis and outpatient management. Berlin Heidelberg: Springer-Verlag; 1985; 75-81.
Notaras MJ. Lateral subcutaneous sphincterotomy for anal fissure - a new techique. Proc R Soc Med 1969: 62:713.
Notaras MJ. The treatment of anal fissure by lateral subcutaneous internal sphincterotomy - a technique and results. Br J Surg 1971; 58:96-100.
Nothmann BJ, Schuster MM. Internal anal sphineter derangement with anal fissures. Gastroenterology 1974; 67:216-20.
Parellada C. Randomized, prospective trial comparing 0.2 percent isosorbide dinitrate ointment with sphincterotomy in treatment of chronic anal fissure: a two-year follow-up. Dis Colon Rectum. 2004 Apr;47(4):437-43. Epub 2004 Mar 4.
Parks AG. The management of fissure-in-ano. Hosp Med 1967; 1:737-9.
Pernikoff BJ, Eisenstat TE, Rubin RJ, Oliver GC, Salvati EP. Reappraisal of partial lateral internal sphincterotomy. Dis Colon Rectum. 1994 Dec;37(12):1291-5.
Copyright (c) 2004 Acta Chirurgica Croatica
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
The authors hereby authorize the Acta Chirurgica Croatica (ACC) to publish their work.
The authors are aware that although ACC is Open Access journal, the copyright of all material published is vested in ACC. Open access articles are freely available to read, download, and share from the time of publication under the terms of the Creative Commons License Attribution ‐ NonCommerical No Derivative (CC BY‐NC‐ND) license. This license does not permit reuse for any commercial purposes nor does it cover the reuse or modification of individual elements of the work (such as figures, tables, etc.) in the creation of derivative works without specific permission of ACC and appropriate acknowledgment of its source. The authors permit ACC to allow third parties to copy any part of the work without asking for permission, provided that the reference to the source is given and that this is not done for commercial purposes. Except for copyright, other proprietary rights related to the work (e.g., patent or other rights to any process or procedure) shall be retained by the author. To reproduce any text, figures, tables, or illustrations from this work in future works of their own, the author must obtain written permission from ACC.
Each of the author(s) hereby also grants permission to ACC to use such author’s name and likeness in connection with any past, present or future promotional activity by ACC, including, but not limited to, promotions for upcoming issues or publications, circulation solicitations, advertising or other publications in connection with ACC. Also, each of the author(s) hereby grants permission to ACC to use the manuscript in editorial research related to the improvement of editorial conduct, decision making, and issues related to peer review.
Each of the author(s) hereby releases and shall indemnify and hold harmless ACC and its successors, assigns, licensees, officers, directors, employees, and their respective heirs and representatives from and against any and all liabilities, losses, damages and expenses arising out of any claims of any kind that may be asserted against any of them based in whole or in part on any breach of the author(s)’ representations or warranties herein or in the work or anything contained in the work, including but not limited to any claims for copyright infringement or violation of any rights of privacy or publicity.
