E. Garciagranero et al., ANAL ENDOSONOGRAPHIC EVALUATION AFTER CLOSED LATERAL SUBCUTANEOUS SPHINCTEROTOMY, Diseases of the colon & rectum, 41(5), 1998, pp. 598-601
PURPOSE: The present study was undertaken to evaluate anal endosonogra
phic results of the transverse and longitudinal extent of internal ana
l sphincter division after closed lateral subcutaneous sphincterotomy
and its relationship to outcome with respect to anal fissure recurrenc
e and postoperative anal incontinence. METHODS: Ten patients selected
for symptomatic anal fissure recurrence (mean follow-up, 10.9 months)
and 41 asymptomatic control patients (mean follow-up, 15.5 months) wer
e reviewed by anal endosonography after closed lateral subcutaneous sp
hincterotomy. Clinical evaluation was focused on anal fissure recurren
ce and postoperative anal incontinence. The anal endosonographic study
involves serial radial images of the distal, proximal, and midanal ca
nal. RESULTS: In 32 patients in whom a complete internal sphincter def
ect was identified, 31 (75.6 percent) were from the control group and
only 1 patient (10 percent) was from the recurrence group (P < 0.001).
In 19 patients, an incomplete internal sphincter defect was identifie
d; 10 (24.4 percent) were from the control group (residual median size
, 1.8 mm; contralateral, 2.5 mm) and 9 patients (90 percent) were from
the recurrence group (P = 0.001; residual median size, 1.4 mm; contra
lateral, 2.2 mm). Ten patients (19.6 percent) were incontinent for gas
and three patients (5.9 percent) for liquid feces, without significan
t differences between groups. CONCLUSIONS: Anal endosonography is a us
eful method for evaluating the anatomic effectiveness of closed latera
l subcutaneous sphincterotomy. An incomplete sphincterotomy is associa
ted with significant symptomatic anal fissure recurrence.