Comparison of controlled-intermittent anal dilatation and lateral internal sphincterotomy in the treatment of chronic anal fissures: A prospective, randomized study

• Published in: International journal of surgery (London, England) Vol. 7; no. 3; pp. 228 - 231
• Main Authors: Yucel, Tayfun, Gonullu, Dogan, Oncu, Mahmut, Koksoy, Ferda Nihat, Ozkan, Sibel Gurdal, Aycan, Omer
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.01.2009
• Subjects: Adolescent; Adult; Anal Canal - surgery; Bleeding; Catheterization - methods; Chi-Square Distribution; Chronic anal fissure; Chronic Disease; Constipation; Controlled-intermittent anal dilatation; Digestive System Surgical Procedures; Double-Blind Method; Female; Fissure in Ano - therapy; Humans; Lateral internal sphincterotomy; Long-term results; Male; Manometry; Middle Aged; Pain; Park's speculum; Postoperative Complications; Prospective Studies; Resting pressure of anal canal; Statistics, Nonparametric; Surgery; Treatment Outcome; Resting pressure of anal canal; Pain; Controlled-intermittent anal dilatation; Chronic anal fissure; Long-term results; Constipation; Bleeding; Park's speculum; Lateral internal sphincterotomy
• ISSN: 1743-9191; 1743-9159
• DOI: 10.1016/j.ijsu.2009.03.006

Abstract Aim The results of controlled-intermittent anal dilatation (CIAD) or lateral internal sphincterotomy (LIS) in the treatment of chronic anal fissures are presented. Material and methods Forty patients who were randomized to two groups underwent CIAD or a LIS. The pre- and post-operative mean anal canal resting pressures (MACRPs) and symptoms were recorded and the results were compared. Results Two months post-operatively, 18 patients in the CIAD group and 17 patients in the LIS group had healed completely, and had no anal incontinence or other complications. The post-operative improvement in pain, bleeding, and constipation did not differ significantly between the two groups. In the CIAD and LIS groups, the pre-operative MACRPs were 89.7 ± 16.5 and 87.6 ± 12.3 mmHg, respectively; 2 months post-operatively, the MACRPs had significantly decreased to 76.9 ± 13.7 and 78.1 ± 11.3 mmHg in the CIAD and LIS groups, respectively. No statistical difference existed in the pre- or post-treatment MACRPs between the groups. Conclusion CIAD applied with a standardized technique reduced anal canal resting pressure and provided symptomatic healing that was equivalent to a LIS. Since there were no findings of incontinence, or situations which resulted in sphincter damage, we conclude that CIAD is suitable for patients with chronic anal fissures because it is less invasive than LIS, with equivalent efficacy and safety. In addition, the CIAD method may be an alternative procedure in older and multiparous women who has a higher risk of incontinence.