Internal anal sphincterolysis for chronic anal fissure: a prospective, clinical, and manometric study

Abstract 

Background

The author proposes a technique of finger fragmentation of internal anal sphincter fibers to relieve anal sphincter spasm in patients with chronic anal fissures. This prospective study evaluates the clinical and functional outcome in a group of patients with chronic anal fissures.

Materials and methods

Forty-five patients suffering from chronic anal fissure underwent the procedure termed “sphincterolysis.” Anal manometry was performed prior to and at 6 and 24 months after treatment. Anal incontinence was evaluated by means of a continence score. Patients were asked to rate the level of satisfaction at the last follow-up.

Results

Forty-four patients completed the study. Symptom control was achieved in 7. 4 ± 3 days in 91% patients whose fissures had healed when examined 4 weeks after the procedure. In 38 of these patients, pain was relieved at the time of first postoperative defecation. Recurrence of fissure was observed in 1 patient at the 6-month follow-up. Three patients had minor continence disturbances, which resolved within 6 months. Anal manometry before and after the procedure showed a significant reduction in mean resting pressure (MRP) (P < .001), while the maximum squeeze pressure before and after the treatment did not reached a statistically significant reduction. As regards satisfaction grading, 79.5% of patients were highly satisfied with the procedure, while another 16% of patients rated the procedure as good.

Conclusion

Internal anal sphincterolysis seems to be an effective, safe and easy procedure, which decreases anal resting pressure and achieves good symptom control with high patient satisfaction.

Keywords: Anal fissure, Manometry, Continence, Sphincterolysis, Internal sphincter