Kliniczna i obrazowa ocena powierzchownej otwartej sfinkterotomii w leczeniu przewlekłej szczeliny odbytu

*Agnieszka Kucharczyk

Summary
Introduction. Anal fissure, as well as haemorrhoid disease, is one of the most common benign diseases of the anus.
Aim. 1. Clinical assessment of the outcomes of surgical treatment of chronic anal fissure by fissure excision in combination with open superficial internal sphincterotomy as compared to the published results of other surgical methods. 2. Pre- and post-operative evaluations of morphology and function of the anal sphincter in the study group.
Material and methods. A group of 50 patients (37 females and 13 males) aged 26-78 who were operated for chronic posterior anal fissure. Preoperative and post-surgery follow-up 7 days, 6 weeks, 3 and 6 months after the surgery, included medical history survey, proctologic examination, manometry and endosonography. The follow-up period was not less than 6 months.
Results. In preoperative endosonography sphincter integrity was preserved in 100% of patients, in 54% of patient sphincter was thickened. Preoperative manometry revealed that the maximal anal voluntary squeeze pressure exceeded 100 mmHg in 76% of patients, and resting pressure was above 30 mmHg in 58% of patients.
Endosonography was performed 3 months after the surgery and did not reveal any complete breaks in the integrity of the internal sphincter. Manometry revealed that the maximal anal voluntary squeeze pressure exceeded 100 mmHg in 74% of patients, and resting pressure was above 30 mmHg in 48% of patients. Control examination performed 6 months after the surgery revealed impaired continence of flatus in 4% of patients and no fissure recurrence was found in any of the patients.
Conclusions. 1. Fissure removal by open subcutaneous internal sphincterotomy is an effective method of surgical treatment of chronic anal fissure and it involves a low risk of incontinence. 2. Preoperative endosonography and manometry are diagnostic methods that may be useful in planning the extent of surgery.

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