Manometric Evaluation of Internal Anal Sphincter after Fissurectomy and Anoplasty for Chronic Anal Fissure: A Prospective Study

Patti, Rosalia; Territo, Valentina; Aiello, Paolo; Angelo, Giuseppe Livio; Vita, Gaetano Di

doi:10.1177/000313481207800531

Cited by 14 publications

(8 citation statements)

References 39 publications

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“…We recorded a low rate of recurrence (6.7%); we observed only 3 “de novo” case of post-operatory anal incontinence, which were temporary and of slight entity; patients who were already suffering experienced a temporary worsening. Moreover, MRP values started significantly reducing from 12 months [ 10 ] after the procedure to reach, at 60 months after surgery, values which were similar to healthy subjects.…”

Section: Discussionmentioning

confidence: 99%

Fisurectomy and anoplasty with botulinum toxin injection in patients with chronic anal posterior fissure with hypertonia: a long-term evaluation

et al. 2020

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Chronic anal fissure's (CAF) etiopathogenesis remain unclear. CAF of the posterior commissure (CAPF) are often characterized by internal anal sphincter (IAS) hypertonia. The treatment of this disease aimed to reduce IAS hypertonia. Due to the high rate of anal incontinence after LIS, the employment of sphincter preserving surgical techniques associated to pharmacological sphincterotomy appears more sensible. The aim of our study is to evaluate the long-term results of fissurectomy and anoplasty with V-Y cutaneous flap advancement associated to 30 UI of botulinum toxin injection for CAPF with IAS hypertonia. We enrolled 45 patients undergone to fissurectomy and anoplasty with V-Y cutaneous flap advancement and 30 UI botulinum toxin injection. All patients were followed up for at least 5 years after the surgical procedure, with evaluation of anal continence, recurrence rate and MRP (Maximum resting pressure), MSP (Maximum restricting pressure), USWA (Ultrasound wave activity). All patients healed within 40 days after surgery. We observed 3 "de novo" post-operative anal incontinence cases, temporary and minor; the pre-operative ones have only temporary worsened after surgery. We reported 3 cases of recurrences, within 2 years from surgery, all healed after conservative medical therapy. At 5 year follow-up postoperative manometric findings were similar to those of healthy subjects. At 5 years after the surgical procedure, we achieved good results, and these evidences show that surgical section of the IAS is not at all necessary for the healing process of the CAPF.

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Section: Discussionmentioning

confidence: 99%

Fisurectomy and anoplasty with botulinum toxin injection in patients with chronic anal posterior fissure with hypertonia: a long-term evaluation

et al. 2020

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“…Preoperative manometric evaluation was performed after a reasonable period of suspension of all medical therapy influencing IAS tone. The manometric evaluation was carried out by a manometric sensor using the station pull-through as described in our previous work [11]. A manometric evaluation has been undertaken at 12 and 24 months after surgery.…”

Section: Methodsmentioning

confidence: 99%

“…Data collected on healthy subjects by our anorectal pathophysiological laboratory showed that normal values of maximum resting pressure (MRP) and maximum squeeze pressure (MSP) were respectively 68.1 ± 12.3 mmHg and 112 ± 36.2 mmHg [11]. The normal range of MRP, according to Jones et al [12], were 45-85 mmHg; so that CAF without hypertonic IAS were defined as those with MRP values < 85 mmHg.…”

Section: Methodsmentioning

confidence: 99%

Safety and effectiveness of saving sphincter procedure in the treatment of chronic anal fissure in female patients

et al. 2021

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Introduction Lateral internal sphincterotomy (LIS) is still the approach of choice for the treatment of chronic anal fissure (CAF) regardless to the internal anal sphincter tone but it is burdened by high risk post-operative faecal incontinence (FI). In female patient there are some anatomical and functional differences of the sphinteric system which make them more at risk of FI and vaginal birth could cause sphinteric lesions affecting the anal continence function. The aim of our study is to evaluate the results of saving sphincter procedure as treatment for female patients affected by CAF. Methods We studied 110 female patients affected by CAF undergone fissurectomy and anoplasty with V–Y cutaneous flap advancement associating pharmacological sphincterotomy in patients with hypertonic IAS. The follow up was at least for 2 years. The goals were patient’s complete healing, the evaluation of FI, recurrence rate and manometry parameters. Results All wounds healed within 40 days after surgery. We recorded 8 cases of recurrences 6 healed with medical therapy and 2 with dilatation. We recorded 2 “de novo” temporary and low grade post-operative cases of FI. Post-operative value of MRP were unmodified in patient with normotonic IAS but significantly lower at 12 months follow up as compared with the pre-operative ones in patients with hypertonic IAS; after 24 months from surgery MRP values were within the normal range. Conclusion The fissurectomy and anoplasty with V–Y cutaneous flap alone or in association with a pharmacological sphincterotomy in patients with hypertonic IAS may represent an effective approach for the treatment of CAF in female patients.

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“…Sphincter-saving procedures have been recently reconsidered as a valuable alternative to reduce the risk of FI in both children and adults[ 6 ]. Among the latter, fissurectomy and anoplasty with a V-Y advancement flap have been employed by our team for a few years, with outstanding results[ 1 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

Botulinum toxin associated with fissurectomy and anoplasty for hypertonic chronic anal fissure: A case-control study

D’Orazio¹,

Geraci²,

Famà³

et al. 2021

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BACKGROUND Lateral internal sphincterotomy is still the approach of choice for the treatment of chronic anal fissure (CAF) with internal anal sphincter (IAS) hypertonia, but it is burdened by high-risk postoperative faecal incontinence (FI). Sphincter saving procedures have recently been reconsidered as treatments to overcome this risk. The most employed procedure is fissurectomy with anoplasty, eventually associated with pharmacological sphincterotomy. AIM To evaluate whether fissurectomy and anoplasty with botulinum toxin injection improves the results of fissurectomy and anoplasty alone. METHODS We conducted a case-control study involving 30 male patients affected by CAF with hypertonic IAS who underwent fissurectomy and anoplasty with V-Y cutaneous flap advancement. The patients were divided into two groups: Those in group I underwent surgery alone, and those in group II underwent surgery and a botulinum toxin injection directly into the IAS. They were followed up for at least 2 years. The goals were to achieve complete healing of the patient and to assess the FI and recurrence rate along with manometry parameters. RESULTS The intensity and duration of post-defecatory pain decreased significantly in both groups of patients starting with the first defecation, and this reduction was higher in group II. Forty days after surgery, we achieved complete wound healing in all the patients in group II but only in 80% of the patients in group I ( P < 0.032). We recorded 2 cases of recurrence, one in each group, and both healed with conservative therapy. We recorded one temporary and low-grade postoperative case of “ de novo ” FI. Manometry parameters reverted to the normal range earlier for group II patients. CONCLUSION The injection of botulinum toxin A in association with fissurectomy and anoplasty with a V-Y advancement flap improves the results of surgery alone in patients affected by CAF with IAS hypertonia.

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Manometric Evaluation of Internal Anal Sphincter after Fissurectomy and Anoplasty for Chronic Anal Fissure: A Prospective Study

Cited by 14 publications

References 39 publications

Fisurectomy and anoplasty with botulinum toxin injection in patients with chronic anal posterior fissure with hypertonia: a long-term evaluation

Fisurectomy and anoplasty with botulinum toxin injection in patients with chronic anal posterior fissure with hypertonia: a long-term evaluation

Safety and effectiveness of saving sphincter procedure in the treatment of chronic anal fissure in female patients

Botulinum toxin associated with fissurectomy and anoplasty for hypertonic chronic anal fissure: A case-control study

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