Sequelae of internal sphincterotomy for chronic fissure in ano

Abstract

A total of 1355 patients underwent internal sphincterotomy for chronic fissure in ano between 1980 and 1985. Surgical data were obtained for 1102 patients, and 829 patients responded to a questionnaire. Of the 1057 for whom the time of healing was recorded, 1033 (97.7 per cent) healed by a mean time of 5.6 weeks. No significant differences in satisfaction with the outcome or in deficits in continence were noted between groups undergoing lateral, bilateral or posterior midline sphincterotomy. Excision of the fissure was found to be unnecessary. According to responses on the questionnaires, deficits in continence ranging from 'sometimes' to 'frequently' included lack of control of flatus (35.1 per cent), soiling of underclothing (22.0 per cent) and accidental bowel movements (5.3 per cent). A significantly higher proportion of patients who had accidental bowel movements were aged over 40 years.

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

“…(12) Minor fecal incontinence and difficulty controlling flatulence are common side effects following surgery. (13) Persistent minor fecal incontinence has been reported in 1.2% to 3.5% of patients; however, this does not appear to be significantly different to the rate of minor fecal incontinence experienced by patients treated with topical GTN. (9) However, in a systematic review carried out by Garg P et al to analyse continence at 2 years or more after lateral internal sphincterotomy for chronic anal fissure, the long term risk of anal incontinence after lateral internal sphincterotomy was found to be quite significant.…”

Chronic Anal Fissure - A Multi Centric Study

“…However larger scale studies were also conducted on 1355 patients by Khubchandani et al in 1989 [14] Anal fissures occur roughly equally in both sexes. However few studies show a male to female ratio of 1:2.6 [15] while other had reported male to female ratio of 2:3 [16]. It is evident from these studies that the most of these patients were females.…”

Esfincterotomia lateral interna associada à hemorroidectomia no tratamento da doença hemorroidária: vantagem ou desvantagem?

“…Referências da literatura têm demonstrado que pacientes portadores de doença hemorroidária, assim como de fissura anal, apresentam pressões anais aumentadas, à custa de hipertonia do esfíncter anal interno 5,6,14 . No entanto, ainda não está bem definido se o aumento da pressão anal é secundário à presença dos coxins vasculares 30,31 , e se interfere no retorno venoso do plexo hemorroidário interno, causando degeneração das estruturas fibromusculares e deslizamento progressivo dos coxins anais 32,33 .…”

“…Alguns autores sugerem que a esfincterotomia lateral interna associada à hemorroidectomia, pode contribuir para uma melhor evolução clínica no pós-operatório (redução da dor, da retenção urinária, da estenose anal e do tempo de cicatrização da ferida operatória) 4,[10][11][12][13] . No entanto, a esfincterotomia, apesar de ter seu valor comprovado no tratamento de fissuras anais crônicas, mostrando bons resultados no relaxamento do esfíncter interno do ânus e conseqüen-te cicatrização da ferida fissurária, provoca alterações esfincterianas irreversíveis, permanentes, podendo mesmo causar algum grau de incontinência fecal 14,15 . Baseados nestas evidências consideramos oportuno e principalmente importante a avaliação, tanto clínica como fisiológica (manometria anorretal), de pacientes submetidos à hemorroidectomia acrescida de esfincterotomia lateral, no sentido de trazer novos subsídios para o tratamento da doença hemorroidária.…”