Endoanal ultrasonographic evaluation of an unhealed anal fissure after the lateral internal sphincterotomy

Abstract

Objectives: The aim of this study was to evaluate the outcomes of the lateral internal sphincterotomy in patients who had unhealed anal fi ssures using the endoanal ultrasonography. Background: Lateral internal sphincterotomy is an effective method in treatment of chronic anal fi ssures, but it is associated with 1 to 5 % unhealing and recurrence rates. Endoanal ultrasonography can be used to evaluate the sphincterotomy and the effi ciency of the treatment. Methods: Totally, 40 patients with unhealed anal fi ssures after the lateral internal sphincterotomy were enrolled consecutively. The fi ssures were diagnosed by proctologic examination in every patient. The results of sphincterotomy were evaluated by the endoanal ultrasonography. Results: There were 23 men and 17 women with the median age 29.7 years (range, 20-44 years). Using the endoanal ultrasonography, an incomplete internal sphincterotomy was detected in 26 of patients. In 12 patients, while the internal sphincter was completely intact, a superfi cial (subcutaneous) external anal sphincterotomy was found. In two patients, although the internal sphincterotomy was observed to be suffi cient, a localized abscess formation of less than 1 cm was detected at the anal crypts level. Conclusion: The use of endoanal ultrasonography in patients with unhealed or recurrent anal fi ssure is a benefi cial diagnostic method in assessing the situations of sphincters after the lateral internal sphincterotomy. Although the lateral internal sphincterotomy is a successful surgical treatment and can be performed easily as an outpatient procedure, it should be performed with the correct and rigorously surgical technique (Tab. 2, Fig. 3, Ref. 31).

Cerrahi sonrası iyileşmeyen kronik anal fissürlü hastalarda Botoks uygulaması başarılı mıdır?

“…Bu bağlamda, cerrahiye rağmen iyileşmeyen anal fissür hastaları karşımıza çıkmaktadır. Bunun nedenlerine bakıldığında, en önemli nedenlerden birinin eksik ya da yetersiz sfinkterotomi olduğu gösterilmiştir [8]. Zaten en önemli komplikasyonlardan birinin inkontinans olması, bu hastalarda LİS yönteminin tekrar uygulanmasında zorluklar yaşatmaktadır.…”