Internal sphincterotomy for chronic anal fissure: Long term effects on anal pressure

Abstract

In 28 patients with chronic anal fissure the median anal canal pressure was 98 cmH2O, significantly higher than in control subjects (P less than 0.001). After lateral internal sphincterotomy the pressure dropped by 50 per cent to normal levels and the fissures healed with no change in pressure over 12 months. Ten patients also had normal anal pressures and were asymptomatic 4-6 years after internal sphincterotomy. Adequate internal sphincterotomy appears to reduce permanently anal canal pressure, suggesting that abnormal activity in the sphincter contributes to the development of a fissure.

Computerized anal vector manometric analysis in patients treated by tailored lateral spincterotomy for anal fissure

“…Our findings of significantly higher mean resting anal pressure in patients with anal fissure compared with controls are in accordance with the observations of others [19][20][21][22][23]. In our series, 30% of patients with anal fissure had normal MRAP, and this is not in agreement with the concept of a global increase of the resting anal pressure in patients with anal fissure [24].…”

Different anal pressure profiles in patients with anal fissure

“…Many investigators found high anal resting pressures, and anal hypertonia was related to the internal anal sphincter because resting pressures returned to normal values after internal sphincterotomy [14,15]. In this study, 78.1% of the patients had chronic fissure at the posterior midline of the anal canal; of these, 44% had anal hypertonia (mean pressure >50 mmHg).…”

Resting Anal Pressure Following Hemorrhoidectomy and Lateral Sphincterotomy

“…1,[5][6][7][8] This could explain why left lateral sphincterotomy or anal dilation might relieve both conditions. 9,10 In the present study both investigated groups had elevated anal resting pressure compared Figure 2.…”

“…Many investigators agree that high anal pressure might be a contributing factor to the pathophysiology of chronic anal fissure. [5][6][7][8] The treatment of choice for both pathologies, when conservative treatment fails, is surgery.…”