Clinical, Manometric, and Ultrasonographic Results of Pneumatic Balloon Dilatation vs. Lateral Internal Sphincterotomy for Chronic Anal Fissure: A Prospective, Randomized, Controlled Trial

Renzi, Adolfo; Izzo, Domenico; Sarno, Giandomenico Di; Talento, Pasquale; Torelli, Francesco; Izzo, Giuseppe; Martino, Natale Di

doi:10.1007/s10350-007-9162-7

Cited by 76 publications

(55 citation statements)

References 26 publications

(19 reference statements)

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“…The PBD group did demonstrate mild transient fecal incontinence; however, at 24-month follow-up, the incidence of incontinence in the PBD group was 0%, but 16% in the LIS group (p<0.0001). [43] Thus, with a better ability to standardize the technique and produce reproducible results, pneumatic balloon dilation may become a preferable alternative to anal dilation.…”

Section: Pneumatic Balloon Dilationmentioning

confidence: 99%

Anal Fissure Revisited : A Systematic Review

Singh¹,

Chandrakar²,

Agrawal³

et al. 2015

jemds

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Anal fissure is one of the most common anorectal problems. Anal fissure is largely associated with high anal sphincter pressures and most treatment options are based on reducing anal pressures. There are many options to treat chronic fissures in ano. Some of them are non-surgical while the others are surgical. The efficacy claimed by each of the prevalent method is very high but the inconsistencies and contraindications are equally strong. To date, lateral sphincterotomy has been favoured by most of the proctologists, because it is the least extensive surgical procedure and is offering a long lasting relief in sphincter spasm. Various management technique are reviewed in this article along with Advancement flap for anterior fissure and a new method combining the age-old technique of Lord's manual dilatation followed by radio surgery is also highlighted along with their complications. The addition of radio surgery is found useful for refreshing the edges of the fissure and to tackle pathologies namely sentinel pile, small internal piles or hypertrophied anal papillae often found associated with chronic fissures. Revisiting the trends of treatment of chronic anal fissures, the most preferred options are the manual dilatation with radio surgery and the subcutaneous lateral anal sphincterotomy. Both methods are easy to perform, have negligible complications and no special setup is needed, except the radio surgical unit, in case of the first procedure.

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Section: Pneumatic Balloon Dilationmentioning

confidence: 99%

Anal Fissure Revisited : A Systematic Review

Singh¹,

Chandrakar²,

Agrawal³

et al. 2015

jemds

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“…Only one patient had transient incontinence to flatus, recovering complete continence 8 weeks after the procedure. Fecal incontinence has been described in up to 16% of the patients submitted to LIS 9,27 , being more common in the first 5 weeks with the recovery rate varying in the literature 23 . However, its incidence may alter according to the surgical technique, length of sphincterotomy and follow-up period 20,28 .…”

Section: Discussionmentioning

confidence: 99%

Clinical and manometric evaluation of women with chronic anal fissure before and after internal subcutaneous lateral sphincterotomy

Silva¹,

Rosa²,

Almeida³

et al. 2012

J. Coloproctol. (Rio J.)

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Silva SM, Rosa VF, Almeida RM, Coura MMA, Oliveira PG, Sousa JB. Clinical and manometric evaluation of women with chronic anal fissure before and after internal subcutaneous lateral sphincterotomy. J Coloproctol, 2012;32(2):148-153. ABSTRACT: Objective:To evaluate clinical and manometric parameters of chronic anal fissure females undergoing lateral internal sphincterotomy (LIS). Methods: A total of eight women with chronic anal fissure who underwent LIS were included in this study. The preoperative assessment was performed one week before surgery and included general and anorectal examination, anorectal manometry, and Jorge Wexner questionnaire. The post operative follow up was made every 15 days until complete healing. Jorge Wexner questionnaires and anorectal manometry were repeated at 1 month and 3 months after the surgery. Time to healing, manometric changes and complications were assessed. Results: All patients had preoperative increased anal resting pressure. The resting pressures and anal canal length were significantly decreased 3 months after surgery. Patients' complaints of itching and bleeding were also reduced. Fissures healed in 7 patients and median healing time was 45 days. No complications were observed due to the procedure. One patient had transient incontinence to flatus. Conclusion: Lateral internal sphincterotomy provided clinical improvement and reduced resting pressure of the internal anal sphincter in women with chronic anal fissure.Keywords: anal fissure; anal canal; manometry; wound healing. RESUMO: Objetivo: Avaliar a evolução clínica e manométrica de mulheres com fissura anal crônica submetidas à esfincterotomia lateral interna subcutânea. Métodos: Estudo prospectivo com oito pacientes. A avaliação inicial foi realizada por meio de questionários, exame fí-sico e manometria anorretal na semana anterior ao procedimento cirúrgico. Durante o período pós-operatório, as pacientes foram avaliadas clinicamente a cada 15 dias, até a cicatrização completa. Os questionários e a manometria anorretal foram repetidos 1 mês e 3 meses após a operação. Foi avaliado o tempo para cicatrização da fissura, as alterações manométricas e as complicações decorrentes do procedimento. Resultados: Todas as pacientes apresentavam hipertonia esfincteriana interna no período pré-operatório. Após 3 meses da operação, as pressões de repouso e o comprimento do canal anal funcional diminuíram de modo estatisticamente significante. Houve redução das queixas de prurido e sangramento. A cicatrização completa da fissura ocorreu em sete pacientes. A mediana do tempo de cicatrização foi de 45 dias. Não houve complicações decorrentes do procedimento. Uma paciente apresentou incontinência transitória para flatos. Conclusões: A esfincterotomia lateral interna subcutânea proporcionou melhora clínica e diminuição das pressões de repouso dos esfíncteres anais em mulheres com fissura anal crônica.Palavras-chave: fissura anal; esfíncter anal; manometria; cicatrização.Clinical and manometric evaluation of women with chronic anal fissu...

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“…There was no recurrence of chronic anal fissure. Acute anal fissures Sphinkterotomie und über eine Inkontinenz von 0% nach Dilatation gegenüber einer Inkontinenzrate von 16% nach lateraler Sphinkterotomie [20]. Nach lateraler Sphinkterotomie des Musculus sphincter ani internus in Lokal-oder Allgemeinanästhesie wird über Heilungsraten zwischen 89,5% und 100% nach 6-8 Wochen berichtet [1,7,15].…”

Section: Fissurectomy Versus Fissurectomy and Lateral Internal Sphincunclassified

“…Um Inkontinenzschäden zu vermeiden, wird als alternative Behandlungsmethode in jüngster Zeit wieder die pneumatische Ballondilatation empfohlen [20]. In der prospektiv-randomisierten Studie [20] konnten Heilungsraten der Fissuren von 83,3% nach pneumatischer Ballondilatation versus 92% nach lateraler interner Sphinkterotomie (LIS) nach 24 Monaten erreicht [7].…”

Section: Diskussionunclassified

Fissurexzision versus Fissurexzision und laterale interne Sphinkterotomie bei der chronischen Analfissur

Hancke¹,

Rikas²,

Schwaner³

et al. 2009

Coloproctol

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ZusammenfassungHintergrund und Ziel: Die Sphinkterotomie des Musculus sphincter ani internus wird als "Goldstandard" in der Behandlung der chronischen Analfissur angesehen, ist aber mit dem Risiko einer analen Inkontinenz behaftet. Bisher liegen keine vergleichenden Langzeitergebnisse nach operativer Behandlung der chronischen Analfissur mit alleiniger Fissurektomie bzw. Fissurektomie mit Sphinkterotomie vor. Die prospektive, randomisierte Studie untersucht die Heilungsraten und Inkontinenzhäufigkeiten nach alleiniger Fissurexzision versus Fissurexzision mit lateraler interner Sphinkterotomie (LIS) 5 Jahre postoperativ. Patienten und Methodik:Bei 60 Patienten (30 Frauen, 30 Männer; Alter 17-77 Jahre) wurde nach Randomisierung entweder eine Fissurexzision (n = 30; Gruppe 1) oder eine Fissurexzision und laterale Sphinkterotomie (n = 30; Gruppe 2) vorgenommen. In einem standardisierten Fragebogen wurden die Patienten präoperativ, 12 Wochen und 5 Jahre postoperativ zu ihren Beschwerden und der analen Kontinenz befragt und proktologisch einschließlich analer Manometrie untersucht.Ergebnisse: Alle Patienten wurden zur Operation in Allgemeinnarkose stationär aufgenommen. Postoperativ traten keine Komplikationen wie Blutung, Infektion oder Harnverhalt auf. Weder im Schmerzgrad während der ersten Defäkation noch bei der Schmerzmedikation konnten signifikante Unterschiede zwischen beiden Gruppen festgestellt werden. 12 Wochen postoperativ waren 73% versus 80% der Fissuren verheilt. Die Fragebögen beantworteten 16 Patienten nach Fissurektomie und 21 Patienten nach Fissurektomie/Sphinkterotomie (61,7%). Nach 5 Jahren bestand eine neu aufgetretene Inkontinenz geringen Grades bei 7/16 Patienten der Gruppe 1 (43,75%) und 10/21 Patienten der Gruppe 2 (47,62%). Kein Patient litt unter einer schweren Inkontinenz. Es bestanden keine signifikanten Unterschiede in der Kontinenz 12 Wochen oder 5 Jahre postoperativ.* Die Daten dieser Arbeit entstammen der Dissertation "Chronische Analfissur -eine Langzeitstudie 5 Jahre nach der operativen Therapie der chronischen Analfissur mittels a) Fissurexzision und Analdilatation, b) Fissurexzision und lateraler Sphinkterotomie und c) Fissurexzision und Deckung des Defektes mittels eines U-Vorschub-Dehnungslappens", vorgelegt im April 2008 beim coloproctology Originalarbeit Hancke E, et al. Fissurexzision mit oder ohne Sphinkterotomie bei chronischer Analfissur 2 coloproctology 31 · 2009 · Nr. 1 © Urban & Vogel 26/60 Patienten (43%; Gruppe 1: n = 13, Gruppe 2: n = 13) vor. Bei keinem Patienten war die chronische Analfissur wieder aufgetreten. In zwei Fällen bestanden akute Analfissuren (Gruppe 1: n = 1, Gruppe 2: n = 1), in vier Marisken (Gruppe 1: n = 3, Gruppe 2: n = 1). Die analen Ruhedrücke waren nach 5 Jahren etwas niedriger als präoperativ, aber noch im Normbereich (Median Gruppe 1: 85/75 mmHg, Gruppe 2: 92/80 mmHg; kein statistisch signifikanter Unterschied). Schlussfolgerung: Die Heilungsraten nach Fissurexzision oder Fissurexzision und lateraler Sphinkterotomie sind gleich. Neu auftretend...

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Clinical, Manometric, and Ultrasonographic Results of Pneumatic Balloon Dilatation vs. Lateral Internal Sphincterotomy for Chronic Anal Fissure: A Prospective, Randomized, Controlled Trial

Abstract: As lateral internal sphincterotomy, pneumatic balloon dilatation grants a high anal fissure-healing rate but with a statistically significant reduction in postoperative anal incontinence.

Cited by 76 publications

References 26 publications

Anal Fissure Revisited : A Systematic Review

Anal Fissure Revisited : A Systematic Review

Clinical and manometric evaluation of women with chronic anal fissure before and after internal subcutaneous lateral sphincterotomy

Fissurexzision versus Fissurexzision und laterale interne Sphinkterotomie bei der chronischen Analfissur

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