Skip to main content
SpringerLink
Log in

Fine-tuning of the Extent of Lateral Internal Sphincterotomy: Spasm-controlled vs. up to the Fissure Apex

  • Original Contribution
  • Published:
Diseases of the Colon & Rectum

Abstract

Purpose

This study was designed to compare the results of controlled lateral internal sphincterotomy by using anal calibrators with those of sphincterotomy up to the fissure apex in a randomized, prospective fashion.

Methods

In the fissure apex group, sphincterotomy was extended to the level of the fissure apex, and in the spasm-controlled group, serial small sphincterotomies and anal caliber measurements followed until an anal caliber of 30 mm was obtained.

Results

The preoperative anal caliber was 24 ± 1.9 (range, 20–28) mm and 24.9 ± 2.44 (range, 19–28) mm in the spasm-controlled and fissure apex groups, respectively (P = 0.127). Postoperatively, the spasm-controlled group had a mean anal caliber of 31.5 ± 1.28 (range, 30–32) mm, and the fissure apex group had 32.5 ± 2.33 (range, 25–37) mm (P = 0.035). In the fissure apex group, a significant negative correlation was determined between the postoperative anal caliber and time of relief of pain (r = −0.568, P = 0.001). The early (7 and 28 days) postoperative anal incontinence scores were significantly higher in the fissure apex group (P = 0.002, P < 0.0001, respectively). A significant positive correlation between the anal caliber measurements and anal incontinence scores at 28 days and 2 months also was noted in the fissure apex group (r = 0.406, P = 0.023; and r = 0.364, P = 0.044).

Conclusions

Controlled sphincterotomy provided a faster relief of pain, and it was associated with a lower rate of early postoperative disturbance of continence and an insignificantly lower rate of treatment failure compared with sphincterotomy up to the fissure apex.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Figure 2
Figure 3

Similar content being viewed by others

References

  1. Schouten WR, Briel JW, Auwerda JJ, De Graaf EJ. Ischaemic nature of anal fissure. Br J Surg 1996;83:63–5.

    Article  PubMed  CAS  Google Scholar 

  2. Brisinda G, Maria G, Bentivoglio AR, Cassetta E, Gui D, Albanese A. A comparison of injections of botulinum toxin and topical nitroglycerin ointment for the treatment of chronic anal fissure. N Engl J Med 1999;341:65–9.

    Article  PubMed  CAS  Google Scholar 

  3. Richard CS, Gregoire R, Plewes EA, et al. Internal sphincterotomy is superior to topical nitroglycerin in the treatment of chronic anal fissure: results of a randomized, controlled trial by the Canadian Colorectal Surgical Trials Group. Dis Colon Rectum 2000;43:1048–57.

    Article  PubMed  CAS  Google Scholar 

  4. Evans J, Luck A, Hewett P. Glyceryl trinitrate vs. lateral sphincterotomy for chronic anal fissure: prospective, randomized trial. Dis Colon Rectum 2001;44:93–7.

    Article  PubMed  CAS  Google Scholar 

  5. Perrotti P, Bove A, Antropoli C, et al. Topical nifedipine with lidocaine ointment vs. active control for treatment of chronic anal fissure: results of a prospective, randomized, double-blind study. Dis Colon Rectum 2002;45:1468–75.

    Article  PubMed  Google Scholar 

  6. Mentes BB, Irkorucu O, Akin M, Leventoglu S, Tatlicioglu E. Comparison of botulinum toxin injection and lateral internal sphincterotomy for the treatment of chronic anal fissure. Dis Colon Rectum 2003;46:232–7.

    Article  PubMed  Google Scholar 

  7. Nelson R. Nonsurgical therapy for anal fissure. Cochrane Database Syst Rev 2006;4:CD003431.

    PubMed  Google Scholar 

  8. Timmcke AE, Hicks TC. Fissure-in-ano. In: Zuidema GD, Condon RE. Shackelford’s surgery of the alimentary tract. 4th ed. Philadelphia: WB Saunders, 1996:322–9.

    Google Scholar 

  9. Garcia-Aguilar J, Belmonte C, Wong WD, Lowry AC, Madoff RD. Open vs. closed sphincterotomy for chronic anal fissure: long-term results. Dis Colon Rectum 1996;39:440–3.

    Article  PubMed  CAS  Google Scholar 

  10. Mentes BB, Ege B, Leventoglu S, Oguz M, Karadag A. Extent of lateral internal sphincterotomy: up to the dentate line or up to the fissure apex? Dis Colon Rectum 2005;48:365–70.

    Article  PubMed  Google Scholar 

  11. Ayantunde AA, Debrah SA. Current concepts in anal fissures. World J Surg 2006;30:2246–60.

    Article  PubMed  Google Scholar 

  12. Khubchandani IT, Reed JF. Sequelae of internal sphincterotomy for chronic fissure in ano. Br J Surg 1989;76:421–4.

    Article  Google Scholar 

  13. Nyam DC, Pemberton JH. Long-term results of lateral internal sphincterotomy for chronic anal fissure with particular reference to incidence of fecal incontinence. Dis Colon Rectum 1999;42:1306–10.

    Article  PubMed  CAS  Google Scholar 

  14. Mentes BB, Tezcaner T, Yilmaz U, Leventoglu S, Oguz M. Results of lateral internal sphincterotomy for chronic anal fissure with particular reference to quality of life. Dis Colon Rectum 2006;49:1045–51.

    Article  PubMed  Google Scholar 

  15. Keighley MR. Fissure in ano. In: Keighley MR, Williams NS. Surgery of the anus, rectum and colon. Philadelphia: WB Saunders, 1993:364–86.

    Google Scholar 

  16. Corman ML. Anal fissure. In: Corman ML. Colon and rectal surgery. 2nd ed. Philadelphia: JB Lippincott, 1990:115–7.

    Google Scholar 

  17. Littlejohn DR, Newstead GL. Tailored lateral sphincterotomy for anal fissure. Dis Colon Rectum 1997;40:1439–42.

    Article  PubMed  CAS  Google Scholar 

  18. Lund JN, Scholefield JH. Aetiology and treatment of anal fissure. Br J Surg 1996;83:1335–44.

    Article  PubMed  CAS  Google Scholar 

  19. Pescatori M. Soiling and recurrence after internal sphincterotomy for anal fissure. Dis Colon Rectum 1999;42:687–8.

    Article  PubMed  CAS  Google Scholar 

  20. Cho D-Y. Controlled lateral sphincterotomy for chronic anal fissure. Dis Colon Rectum 2004;48:1037–41.

    Article  Google Scholar 

  21. Jorge JM, Wexner SD. Etiology and management of fecal incontinence. Dis Colon Rectum 1993;36:77–97.

    Article  PubMed  CAS  Google Scholar 

  22. Rudd WW. Lateral subcutaneous internal sphincterotomy for chronic anal fissure, an outpatient procedure. Dis Colon Rectum 1975;18:319–23.

    Article  PubMed  CAS  Google Scholar 

  23. Pernikoff BJ, Eisenstat TE, Rubin RJ, Oliver GC, Salvati EP. Reappraisal of partial lateral internal sphincterotomy. Dis Colon Rectum 1994;37:1291–5.

    Article  PubMed  CAS  Google Scholar 

  24. Hananel N, Gordon PH. Lateral internal sphincterotomy for fissure-in-ano revisited. Dis Colon Rectum 1997;40:597–602.

    Article  PubMed  CAS  Google Scholar 

  25. Lewis TH, Corman ML, Prager ED, Robertson WG. Long-term results of open and closed sphincterotomy for anal fissure. Dis Colon Rectum 1988;31:368–71.

    Article  PubMed  CAS  Google Scholar 

  26. Farouk R, Monson JR, Duthie GS. Technical failure of lateral sphincterotomy for the treatment of chronic anal fissure: a study using endoanal ultrasonography. Br J Surg 1997;84:84–5.

    PubMed  CAS  Google Scholar 

  27. Sultan AH, Kamm MA, Nicholls RJ, Bartram CL. Prospective study of the extent of internal anal sphincter division during lateral sphincterotomy. Dis Colon Rectum 1994;37:1031–3.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Gazi University Medical School, Ankara, Turkey

    B. Bülent Menteş M.D., Melike Karen Güner M.D., Sezai Leventoglu M.D. & Nusret Akyürek M.D.

Authors
  1. B. Bülent Menteş M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Melike Karen Güner M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sezai Leventoglu M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nusret Akyürek M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to B. Bülent Menteş M.D..

Additional information

Reprints are not available

About this article

Cite this article

Menteş, B.B., Güner, M.K., Leventoglu, S. et al. Fine-tuning of the Extent of Lateral Internal Sphincterotomy: Spasm-controlled vs. up to the Fissure Apex. Dis Colon Rectum 51, 128–133 (2008). https://doi.org/10.1007/s10350-007-9121-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10350-007-9121-3

Key words

Search

Navigation