SciELO - Scientific Electronic Library Online

 
vol.47 issue4 author indexsubject indexarticles search
Home Pagealphabetic serial listing  

Services on Demand

Article

Indicators

Related links

  • On index processCited by Google
  • On index processSimilars in Google

Share


South African Journal of Surgery

On-line version ISSN 2078-5151
Print version ISSN 0038-2361

S. Afr. j. surg. vol.47 n.4 Cape Town Nov. 2009

 

GENERAL SURGERY

 

Long-term prospective randomised clinical and manometric comparison between surgical and chemical sphincterotomy for treatment of chronic anal fissure

 

 

H. M. Abd ElhadyI; I. H. OthmanI; M. A. HablusI; T. A. IsmailI; M. H AboryiaI; M. F. SelimII

IM.D; Department of General Surgery, Tanta University, Egypt
IIM.D; Department of Internal Medicine, Tanta University

 

 


ABSTRACT

AIM: To compare surgical and chemical sphincterotomy for treatment of chronic anal fissure.
METHODS: The 160 patients studied were randomly divided into four equal groups, treated by lateral internal sphincterotomy (group S), local diltiazem ointment (group D), local glyceryl trinitrate ointment (group GTN), or injection of botulinum toxin into the internal anal sphincter (group BT). Anal manometry was performed before and 3 months after treatment. Patients were followed up for 5 years.
RESULTS: Complete pain relief was achieved in means (± standard deviation) of 5.7±7.8 days (group S), 15.7±5.9 days (group D), 15.6±5.9 days (group GTN) and 2.7±3.6 days (group BT). The mean times to healing were 4.5±1.2 weeks (group I), 5.1±1.1 weeks (group D), 5.0±1.1 weeks (group GTN) and 5.1±1.3 weeks (group BT). Mean resting and squeeze anal pressures decreased significantly after sphincterotomy. Recurrence rates were 10% in group S, 65% in group D, 57.5% in group GTN and 52.5% in group BT.
CONCLUSION: Lateral internal sphincterotomy is an easy procedure with satisfactory results, minimal complications and a low recurrence rate. Medical sphincterotomy is safe and easy, with mild complications. Its effect is reversible, and relapse is common. We recommend that medical sphincterotomy be tried before surgery or in patients who are unable or unwilling to undergo surgery.


 

 

“Full text available only in PDF format”

 

 

REFERENCES

1. García Aguílar J, Montes CB, et al. Incontinence after lateral Internal sphincterotomy: Anatomic and functional evaluation. Dis Colon Rectum 1998; 41: 423-427.         [ Links ]

2. Tranqui P,Trottier DC, CharlesVictor J, Freeman JB. Nonsurgical treatment of chronic anal fissure: nitroglycerin and dilatation versus nifedipine and botulinum toxin. Can J Surg 2006; 49(1): 41-45.         [ Links ]

3. Dorfman G, Levitt M, Platell C. Treatment of chronic anal fissure with topical glyceryl trinitrate. Dis Colon Rectum 1999; 42: 1007-1010.         [ Links ]

4. Carapeti EA, Kamm MA, Phillips RK. Topical diltiazem and bethanechol decrease anal sphincter pressure and heal anal fissures without side effects. Dis Colon Rectum 2000; 43: 1359-1362.         [ Links ]

5. Madalinski M, Kalinowski L. Novel options for the pharmacological treatment of chronic anal fissure - role of botulin toxin. Curr Clin Pharmacol 2009; 4: 47-52.         [ Links ]

6. Lund JN, Armitage NC, Scholefield JH. Use of glyceryl trinitrate ointment in the treatment of anal fissures. Br J Surg 1996; 83: 776-777.         [ Links ]

7. Ho KS, Ho YH. Randomized clinical trial comparing oral nifedipine with lateral anal sphincterotomy and tailored sphincterotomy in the treatment of chronic anal fissure. Br J Surg 2005; 92: 403-408.         [ Links ]

8. Hananel N, Gordon PH. Lateral internal sphincterotomy for fissure-in-ano. Revisited Dis Colon Rectum 1997; 40: 597-602.         [ Links ]

9. Lewis TH, Corman ML, Prager ED, Robertson WG. Long term results of open and closed sphincterotomy for anal fissure. Dis Colon Rectum 1988; 31: 368-371.         [ Links ]

10. Hoffmann DC, Goligher JC. Lateral subcutaneous internal sphincterotomy in treatment of anal fissure. BMJ 1970; 3: 673.         [ Links ]

11. DasGupta I, Franklin J, Dawson PM. Successful treatment of chronic anal fissure with diltiazem gel. Colorectal Dis 2002; 4: 20-22.         [ Links ]

12. Watson SJ, Jamm MA, Nicholles RJ, Phillips PK. Topical glyceryl trinitrate in the treatment of chronic anal fissure. Br J Surg 1996; 83: 771-775.         [ Links ]

13. Fruehauf H, Fried M, Wegmueller B, Bauerfeind P, Thumshirn M. Efficacy and safety of botulinum toxin injection compared with topical nitroglycerin ointment for the treatment of chronic anal fissure: a prospective randomized study. Am J Gastroenterol 2006; 101(9): 2107-2112.         [ Links ]

14. Minguez M, Herreros B, Espi A. Long-term follow-up (42 months) of chronic anal fissure after healing with botulinum toxin. Gastroenterology 2002; 123: 112-117.         [ Links ]

15. Arroyo A, Pérez F, SerranoP, Candela F, Lacueva J, Calpena R. Surgical versus chemical (botulinum toxin) sphincterotomy for chronic anal fissure: long-term results of a prospective randomized clinical and manometric study. Am J Surg 2005; 189: 429-434.         [ Links ]

16. Pitt J, Williams S, Dawson PM. Reason for failure of glyceryl trinitrate treatment of chronic fissure-in-ano. A multivariate analysis. Dis Colon Rectum 2001; 44: 864-867.         [ Links ]

17. Xynos E, Tzortzinis A, Chrysos E. Anal manometry in patients with fissure-in-ano before and after internal sphincterotomy. Int J Colorectal Dis 1993; 8: 125-128.         [ Links ]

Creative Commons License All the contents of this journal, except where otherwise noted, is licensed under a Creative Commons Attribution License