Clinical, functional and morphologic evaluation of patients undergoing lateral sphincterotomy for chronic anal fissure treatment. Identification of factors that can interfere with fecal continence

Abstract

Objective Evaluate clinical, functional and morphologic outcomes of lateral sphincterotomy for chronic anal fissure treatment, and correlate the findings with factors that influence in the anal continence. Method In a prospective study, female patients treated by lateral sphincterotomy for chronic anal fissure were assessed using Wexner's incontinence score and grouped according to score: group I (score = 0) and group 2 (score ≥1) and evaluated with anal manometry and anorectal 3D ultrasonography. Results Thirty-six womens were included, 33% had vaginal delivery. Seventeen patients were included in group I and 19 in group II. We found no difference in age, parity and mode of delivery between groups. A significant difference with respect to percentage reduction in resting pressures was noted, when comparing group 1 versus group 2. The anal sphincter muscle length was similar in both groups. However, the length and percentage of transected internal anal sphincter was significantly greater in group II. Conclusion There was a correlation between fecal incontinence symptoms after sphincterotomy with the percentage of resting pressure reduction, length and percentage of transected internal anal sphincter.

Safety and effectiveness of saving sphincter procedure in the treatment of chronic anal fissure in female patients

“…Available research focusing on LIS outcomes in female patients are few. Regadas et al [46] and Fernandes et al [47] analyzed respectively a series on 31 and 36 female patients affected by CAF hypertonic IAS, without FI or previous proctological procedure, who underwent LIS extended to the apex of the fissure; they observed, in the 52-53% of cases. The authors highlighted, with a post-operative evaluation endoanal ultrasound (EAUS), that if LIS extension was greater than 20-25% of the IAS length (corresponding to less than 1 cm), the incidence of FI was significantly higher.…”