Study of Anorectal Manometry changes in Anal Fissure

Abstract

Nowadays, wide range of population experience proctologic pathologies at least once in their lives. 10-15% of proctologic pathologies patients suffer from anal fissure that impair their usual life. So it is mandatory to know how to achieve effective treatment for anal fissure. Aim of Study: The aim of this study is to establish any predictive value of anorectal manometry in assessing the effectiveness of anal fissure treatment.Patients and Methods: This is a prospective study done on 30 patients recruited from outpatient clinic in Benha University divided into two groups whereas group (A) included 15 patients with acute anal fissure (less than six weeks from onset of disease), and group (B) included 15 patients with chronic anal fissure (more than six weeks from onset of disease). Anomanometry was done for all patients and the results were compared.Results: patients with acute anal fissure showed normotensive anal resting pressure (Mean±SD 50.8 ± 5.76 mmHg in males and 64.4 ± 5.81 mmHg in females), while those with chronic anal fissure showed high resting pressure (Mean±SD 88.3 ± 6.18 mmHg in females and 88.65±1.05 mmHg in males).Conclusion: we can conclude that acute anal fissure disease is not usually associated with elevated resting anal pressure but chronic anal fissure is usually associated with hypertensive anal resting pressure in majority of patients. These manometric findings may explain why most cases of acute case anal fissure can be treated medically while cases with chronic anal fissure usually need surgical intervention that liberates anal pressure from hypertensive state to normotensive state. We also can predict that patients with chronic anal fissure associated with normotensive resting anal pressure may be treated either medically or surgically without doing internal sphincterotomy.