Ocena ultrasonograficzna mięśni zwieraczy odbytu u pacjentów przed operacją i po operacji przewlekłej szczeliny odbytu – badanie prospektywne

Agnieszka Kucharczyk¹, *Małgorzata Kołodziejczak¹, Iwona Sudoł-Szopińska^{1, 2, 3}

Summary
Anal fissura is a common diseases which can occur in any age. Among different theories concerning its etiopathogenesis an abnormal function/pressure of internal anal sphincter is underlined.
Aim. Aim of the paper was the endosonographic assessment of internal anal sphincter in patients treated for anal fissura.
Material and methods. 14 patients (11 women and 3 men), aged 26-78 year (mean age 62.7) were surgically treated for anal fissura between October 2008 and February 2011. All patients had anal endosonography performed before surgery and 3 months after fissurectomy, on BK Medical scanner with 3D transducer of frequency 10 MHz.
Results. Pre-operatively thickness of the internal anal sphincter was between 2.2 mm-4.5 mm, in 50% of the patients exceeded 3 mm. Continuity and echogenicity of the muscle were preserved. After fissurectomy, thickness of the anterior part of the sphincter increased from 3.2 mm to 5.5 mm in 50% of the patients, together with thinning of the sphincter posteriorly in the area where fissurectomy was performed in 35.7% and in 14.3% of the patients within its posterior part a tear of the sphincter. After surgery, thickness of the muscle did not exceeded 3 mm in 50% of the cases, including 21.4% of the patients where it did not change at all, in 14.3% thinning was observed in the location of sfincterotomy, and in remaining 14.3% of the cases posterior aspect of the sphincter was disrupted.
Conclusions. 1. In 50% of the patients with a chronic anal fissura thickness of the internal anal sphincter exceeded 3 mm, what could correspond with an abnormal function of this sphincter.
2. Follow-up anal endosonography in these patients showed the preserved thickness of the muscle cases what could reflect compensatory hypertrophy of the sphincter.

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