ANAL ENDOSONOGRAPHIC EVALUATION AFTER CLOSED LATERAL SUBCUTANEOUS SPHINCTEROTOMY

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.