The ideal lateral internal sphincterotomy: clinical and endosonographic evaluation following open and closed internal anal sphincterotomy

Autor: A. Sanahuja, Stephanie García-Botello, Blas Flor, Pedro Esclapez, Miguel Minguez, Alejandro Espí, Eduardo García-Granero, Salvador Lledó, Omar Faiz
Rok vydání: 2009
Předmět:
Zdroj: Colorectal Disease. 11:502-507
ISSN: 1463-1318
1462-8910
DOI: 10.1111/j.1463-1318.2008.01645.x
Popis: To evaluate the relationship between extent of internal sphincter division following open and closed sphincterotomy, as assessed by anal endosonography, with fissure persistence/recurrence and faecal incontinence.A total of 140 consecutive patients undergoing lateral internal sphincterotomy (LIS) for idiopathic chronic anal fissure were prospectively studied. Preoperative clinical assessment was performed together with a postoperative clinical and endosonographic examination. Three zones of the internal sphincter, identifiable by endosonography, were used to describe the uppermost extent of LIS. Primary end-points were fissure persistence/recurrence and faecal incontinence.A total of 140 patients, median age 49.5 years (IQR: 38-56 years) were included. Seventy-five (53.6%) and 65(46.4%) patients underwent percutaneous LIS (PLIS) and open LIS (OLIS) respectively. Median follow-up was 21 months (IQR: 14-29 months). Persistence and recurrence rates were 2.9% (4/140) and 5.7% (8/140) respectively. 7.9% (11/140) patients scored3 on the Jorge and Wexner Faecal Incontinence scale. PLIS was associated with a trend towards higher fissure persistence/recurrence rates than OLIS (12.0%vs 4.6%, P = 0.141). OLIS was significantly associated with a higher proportion of complete sphincterotomies (CS) than PLIS (56/65 vs 48/75, P = 0.003). A CS was associated with a lower fissure persistence or recurrence rate (1/104 vs 11/36, P0.001) but higher incontinence scores (11/104 vs 0/36 cases with Wexner scores3, P = 0.042) than following incomplete sphincterotomy. There was a strongly significant increase in incontinence scores (P0.001) and decrease in recurrence rates (P0.001) with increasing length of sphincterotomy.We recommend a short and CS using either PLIS or OLIS for the treatment of idiopathic anal fissure.
Databáze: OpenAIRE
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