Computerized anal vector manometric analysis in patients treated by tailored lateral spincterotomy for anal fissure

Abstract

FACL, 3.30 ± 0.25 cm; HPS, 1.05 ± 0.36 cm; D1/D2 =1.18 ± 0.46). The percent MRAP reduction was nearly constant after TLS, regardless of the type of patients (36.85 ± 15.04% in hypertensives, 30.48 ± 16.62% in normotensives). TLS resulted in hypotonia, which was more evident in females (MRAP = 57.00 ± 7.75 cm H 2 O) and normotensive patients (MRAP = 48.60 ± 9.08 cm H 2 O). Two patients (6.66%) had persistent fissure after TLS. Soiling and imperfect control of flatus were reported by two patients (6.66%). Following tailored lateral sphincterotomy, the anal physiology was significantly more preserved in hypertensive than in normotensive patients. The success rate of TLS closely approximated that of traditional lateral sphincterotomy with less incidence of continence disorders. A more careful preservation of the sphincter is required in normotensive patients.

Different anal pressure profiles in patients with anal fissure

“…This group of patients had a high pressure profile along the entire anal canal, which reached a maximum 2 cm from the anal verge (p<0.05). A similar experience was recently reported [16]. This observation suggests that the posterior midline is more disposed to injury than the other anal areas, and is in accordance with the ischemic theory.…”

“…Tailored sphincterotomy, devised to reduce the amount of sphincter division, reduces the anal resting pressure by 30%-35% and produces significantly lower incontinence rates [16]. It is difficult to explain why there is anal hypertonia and, at present, we are not able to discriminate if high resting anal pressures are the expression of a local spasm in response to pain caused by the fissure or a primary etiologic factor.…”

Functional outcome following lateral internal anal sphincterotomy for chronic anal fissure

“…We enjoyed the article by Garcea et al . [1] and note that there are very few prospective studies assessing the functional outcome following lateral internal anal sphincterotomy for chronic anal fissure, particularly when it is minimized in its extent [2]. Pescatori et al .…”

“…We enjoyed the article by Garcea et al [1] and note that there are very few prospective studies assessing the functional outcome following lateral internal anal sphincterotomy for chronic anal fissure, particularly when it is minimized in its extent [2]. Pescatori et al [3] have shown that there appears to be less faecal soiling after this procedure when tailored sphincterotomy is reserved for topically resistant chronic anal fissure if the pre-operative manometry of the patient is normal or when standard length sphincterotomy from the dentate line is performed for patients with pre-operative resting anal sphincter hypertonia.…”