Comparison of controlled-intermittent anal dilatation and lateral internal sphincterotomy in the treatment of chronic anal fissures: A prospective, randomized study

Yücel, Tayfun; Gönüllü, Doğan; Oncu, Mahmut; Köksoy, Ferda Nihat; Ozkan, Sibel Gurdal; Aycan, Omer

doi:10.1016/j.ijsu.2009.03.006

Cited by 42 publications

(35 citation statements)

References 20 publications

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“…6,7,[9][10][11] Majority that is 70% are observed in 20 to 40 years which is also consistent with the literature. Male to female ratio was practically equal 1.07:1 suggesting the equal distribution of gender in patients suffering from chronic fissure in ano.…”

Section: Discussionsupporting

confidence: 91%

“…The mean duration of pain was 12 months in the present study, which is quite consistent with the literature and this signifies that the study includes the cases with chronic fissure in ano. 6,[9][10][11] The site of fissure in the majority of patients (83.3%) was at posterior midline (6 o'clock position). Fissure at anterior midline (12 o'clock) was seen in 9.3% patients and fissure at both anterior and posterior midline is seen in 7.4% patients.…”

Section: Discussionmentioning

confidence: 99%

“…These results are consistent with the literature. 10,11,16 The only theoretical advantage of segmental internal sphincterotomy is decrease in the occurrence of postoperative incontinence. The present study also showed that there was no statistically significant difference between the two procedures in terms flatus incontinence.…”

Section: Discussionmentioning

confidence: 99%

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A comparison of segmental internal sphincterotomy versus lateral internal sphincterotomy in management of chronic fissure in ano

et al. 2017

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INTRODUCTIONFissure in ano is a common benign and painful proctologic disease causing considerable morbidity and affecting the quality of life. 1 The cause of fissure in ano remain to be defined but expected view is a combined effect of constipation (hard stools), internal anal sphincter hypertonia and certain predisposing factors like smoking, alcohol consumption of high fat diet, non-vegetarian diet etc.2-4 Medical management is the first line of treatment in all fissure in ano which aims to regulate the bowel movements by high fiber diet, stool softener, osmotic laxatives and topical medications which consist of local anaesthetic and anti-inflammatory agent which reduces the local pain and irritation. The ideal treatment for reducing the hypertonicity of anal sphincter is debatable and it could be medical or surgical manipulation which remains the cornerstone of the treatment. 2 Lateral internal sphincterotomy, remains the most effective and timetested surgical procedure for treatment of chronic fissure ABSTRACT Background: Fissure in ano is one of the commonest benign and painful proctologic condition encountered in surgical practice treated by conservative line of management. Lateral sphincterotomy is the ideal treatment option for chronic refractory fissure in ano. A newer modality segmental internal sphincterotomy shows good promise in terms of early resolution of symptoms, fissure healing and prevention of anal incontinence involving division of the internal sphincter at two different levels. Methods: In comparative nonrandomized trial patients with chronic fissure in ano satisfying the inclusion and exclusion criteria were allocated to lateral sphincterotomy and segmental internal sphincterotomy groups. The outcome factors were perianal sepsis, pain relief using VAS as assessed on passing the first motion, duration of healing of fissure, assessment of incontinence using Wexner's continence score on 30 th post-operative day. Results: A total of 54 cases were enrolled, of them 31 patients underwent lateral internal sphincterotomy and 23 underwent segmental internal sphincterotomy with the mean age of patient was 34.76 years and a male to female ratio of 1.07:1. The pain score (VAS) on passing stool for the first time postoperatively was 4.5 with lateral sphincterotomy and 3.91 with segmental internal sphincterotomy which was statistically significant (P value < 0.010). The duration of postoperative healing was observed to be 27.94 days and 28.09 days in lateral sphincterotomy and segmental internal sphincterotomy group respectively. The post-operative anal incontinence was evaluated by using Wexner's continence grading after one month which was not statistically significant between two groups. Conclusions: Segmental internal sphincterotomy could be a good surgical modality with its healing effect on fissure in ano and post-operative complications which are similar to standard lateral internal sphincterotomy.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

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A comparison of segmental internal sphincterotomy versus lateral internal sphincterotomy in management of chronic fissure in ano

et al. 2017

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“…(5) In the early 1990s, however, being a repeatable method anal dilation proved to be very effective and showed a very low incidence of side effects. Since then at least one controlled, randomised study has shown there to be a little difference in healing rates and complications between controlled anal dilation and lateral internal sphincterotomy, (7) while another has again shown high success rates with anal dilation coupled with low incidence of side effects. (16) The results of anal dilatation using a bivalve anoscope, also called as endoscopic dilatation are comparable with those of lateral sphincterotomy and can be achieved at a lower complication rate with only minor and temporary complications and performed by physicians with no specific surgical training.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Lateral Internal Sphincterotomy and Controlled Intermittent Anal Dilatation in the Treatment of Chronic Anal Fissures: A Prospective, Randomised Study

Correia¹,

Audi²,

Noronha³

2016

jemds

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AIMS AND OBJECTIVEThe main aim of this study was to assess the relief of symptoms and the healing of the anal fissure using the two techniques of lateral internal sphincterotomy and controlled intermittent anal dilatation. MATERIALS AND METHODSThirty patients who were randomised into two groups underwent lateral internal sphincterotomy or controlled intermittent anal dilatation. Randomisation to treatment by either lateral internal sphincterotomy or controlled intermittent anal dilatation was done on the basis whether the patient's registration number was odd or even. A total of 16 patients were treated by lateral internal sphincterotomy and 14 patients by controlled intermittent anal dilatation. All cases were done under general anaesthesia. The improvement in patient's symptoms as well as healing of the fissure were recorded and the results were compared. No serious complications were observed in either group. Patients were followed up for six months post procedure. RESULTSNo differences were observed with respect to immediate relief of pain, bleeding, mucous discharge, healing of the anal fissure, surgical complications and time off work. The post-operative symptoms in the form of pain, bleeding and constipation did not differ significantly between the two groups and were easily controlled with analgesic, stool softeners and sitz baths. The patients were also asked to hydrate themselves well and advised to have a diet rich in vegetables and fruit. Two months post-operatively, 16 patients in the lateral sphincterotomy group and 14 patients in the controlled intermittent anal dilatation group had healed completely and had no anal incontinence or other serious complications. At 6 months follow-up however 2 patients in the anal dilatation group complained of impaired control of flatus and faeces, although there was no soiling of the underwear. At the same point in time, one patient in the sphincterotomy group and 3 patients in the anal dilatation group had a recurrence. No statistical difference however existed in either treatment groups as regards to the relief of symptoms, the healing of the fissure and anal incontinence. CONCLUSIONLateral internal sphincterotomy is one of the most favoured procedures. The reason for this is the simplicity of the procedure, the minimal anaesthesia requirements and excellent results. Controlled intermittent anal dilatation applied with a standardised technique reduced anal canal resting pressure, cured symptoms and provided symptomatic healing that was equivalent to that of a lateral internal sphincterotomy. Since there were no findings of incontinence or situations which resulted in anal sphincter damage, we conclude that controlled intermittent anal dilatation is suitable for patients with chronic anal fissures because of its less invasive nature as compared to lateral sphincterotomy with equivalent efficacy and safety. In addition, the controlled intermittent anal dilatation method may be an alternative procedure in older and multiparous women who has a higher risk o...

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“…Une « sphinctérolyse » correspondant à une rupture des fibres du sphincter interne par un appui ferme d'un doigt intra-canalaire permet 96,5 % de cicatrisation avec 3,5 % d'incontinence anale récupérant dans 97 % des cas [53]. Une dilatation contrôlée avec un dilatateur anal ouvert progressivement jusqu'à 48 mm par intermittence [54] ou avec un ballon pneumatique [55] a été comparée à la sphinctérotomie latérale interne. Les résultats sont encourageants, similaires à la sphinctérotomie en termes de cicatrisation avec une tendance à moins d'incontinence anale.…”

Section: Dilatation Analeunclassified

Mise au point sur la prise en charge des fissures anales

Higuero¹

2015

Journal de Chirurgie Viscérale

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Comparison of controlled-intermittent anal dilatation and lateral internal sphincterotomy in the treatment of chronic anal fissures: A prospective, randomized study

Cited by 42 publications

References 20 publications

A comparison of segmental internal sphincterotomy versus lateral internal sphincterotomy in management of chronic fissure in ano

A comparison of segmental internal sphincterotomy versus lateral internal sphincterotomy in management of chronic fissure in ano

Comparison of Lateral Internal Sphincterotomy and Controlled Intermittent Anal Dilatation in the Treatment of Chronic Anal Fissures: A Prospective, Randomised Study

Mise au point sur la prise en charge des fissures anales

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