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Laterale, partielle Sphinkteromyotomie zur Therapie der chronischen Analfissur

Langzeitergebnisse einer epidemiologischen Kohortenstudie

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Zusammenfassung

Zielsetzung

An Patienten, welche vor Jahren an unserer Klinik wegen einer chronischen Analfissur einer lateralen, partiellen, internen, offenen Sphinkteromyotomie unterzogen wurden, fiel auf, dass sie überproportional häufig an unterschiedlich schweren Formen analer Inkontinenz leiden. An einem repräsentativen Gesamtkollektiv wurde durch explizite Exploration prä- und postoperativ geprüft, ob dieser inzidentellen Beobachtung eine generelle Bedeutung zukommt.

Patienten und Methoden

Die perioperativen Daten von 523 Patienten, die wir zwischen 1986 und 1997 einer Sphinkteromyotomie nach Parks unterzogen haben, wurden uni- und multivariat analysiert.

Ergebnisse

Von 209 nachuntersuchten Patienten war die chronische Analfissur bei 94,7% nach operativer Therapie saniert. Bis zur 12. Woche postoperativ waren insgesamt 14,8% der Operierten überwiegend im Stadium I/II inkontinent. Dieser Anteil erhöhte sich bis zur Nachuntersuchung auf 21%, überwiegend im Stadium II/III nach Parks, signifikant differierend zu einer gesunden Kontrollgruppe.

Schlussfolgerungen

Die laterale Sphinkteromyotomie führt in den meisten Fällen zu einer schnellen Ausheilung der chronischen Analfissur mit geringer Rezidivrate. Mit dem Hinzutreten degenerativer Veränderungen ist dies jedoch langfristig mit einer erhöhten Rate analer Inkontinenz zunehmender Schwere verbunden.

Abstract

Aim

We observed a relatively high rate of severe forms of anal incontinence in patients who had undergone lateral, partial, internal, open sphincterotomy for chronic fissure in ano years ago in our clinic. An explicit investigation of pre- and postoperative data for a representative patient group was undertaken to find out whether this incidental finding proved to be meaningful.

Patients and methods

The perioperative data from 523 patients who underwent sphincterotomy (Parks) between 1986 and 1997 were analyzed by uni- and multivariate analysis.

Results

Of 209 patients included in the study, 94.7% could be considered healed after operation. Up until the 12th postoperative week, 14.8% of patients were incontinent in stage I and II (Parks). This increased up to 21% at the time of follow-up, mainly in stage II and III, which significantly differed from a healthy control group.

Conclusion

Lateral sphincterotomy leads in most cases to quick healing of the chronic fissure in ano with a low recurrence rate. The added effect of degenerative changes was observed to be linked, however, with a higher long-term rate of anal incontinence.

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Authors and Affiliations

  1. Klinik für Visceral-, Thorax- und Gefäßchirurgie, Philipps-Universität Marburg

    C. Hasse, M. Brune & M. Rothmund

  2. Institut für Theoretische Chirurgie, Philipps-Universität Marburg

    W. Lorenz & H. Sitter

  3. Chirurgische Klinik, Stadtkrankenhaus Korbach

    S. Bachmann

  4. Klinik für Visceral-, Thorax- und Gefäßchirurgie, Philipps-Universität Marburg, Baldingerstraße, 35043, Marburg

    C. Hasse

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  1. C. Hasse
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  2. M. Brune
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  4. W. Lorenz
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  5. M. Rothmund
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  6. H. Sitter
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Correspondence to C. Hasse.

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Hasse, C., Brune, M., Bachmann, S. et al. Laterale, partielle Sphinkteromyotomie zur Therapie der chronischen Analfissur. Chirurg 75, 160–167 (2004). https://doi.org/10.1007/s00104-003-0758-8

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  • DOI: https://doi.org/10.1007/s00104-003-0758-8

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