Is manometry essential for surgery of chronic fissure-in-ano?

Abstract

Electromanometric examinations showed that internal sphincterotomy significantly reduces pressure within the anal canal, thus permitting the anal fissure to heal. No significant continence problems were observed. Although manometric selection of patients leads to different results regarding both postoperative continence and recurrence, these differences are not statistically significant. Therefore, it follows that, in experienced hands and using a standardized technique, manometry before surgical management of anal fissure by lateral sphincterotomy is probably superfluous.

Closed vs Open Lateral Internal Sphincterotomy in Chronic Anal Fissure: A Randomized Study to Compare Post-Operative Complications and Results

“…Both the methods are better in terms of least post-operative pain and recurrence. Lateral internal sphincterotomy has some level of temporary incontinence postoperatively, with few patients having permanent incontinence of flatus and faeces [10][11][12][13] . In the recent time it has remained a matter of debate that which process is better.…”

Mild and Severe Anal Incontinence after Lateral Internal Sphincterotomy: Risk Factors, Postoperative Anatomical Findings and Quality of Life

“…Most of the disease occurs in the posterior midline of the anal canal. Morphometric studies of the capillaries have provided the anatomic basis for local ischemia of the anoderma in the posterior midline [1,2,3]. …”

The effect of lateral internal sphincterotomy on resting anal sphincter pressures*

“…Decreases in anal pressures were statistically significant. Despite the limited data in the literature, surgical sphincterotomy is shown to reduce the anal sphincter tone effectively (22,23). Decreased anal sphincter tone results in the healing of anal fissures and low recurrence rates (24).…”