Abstract
The motility pattern of the internal anal sphincter was estimated manometrically in 42 patients with fissure-in-ano before and after left lateral internal sphincterotomy (LAS). Resting anal pressure and anal pressure during straining were significantly higher in patients than in controls (132±21 SD cmH2O vs 81±14SD cmH2O P<0.0002 and 46±16SD cmH2O vs 13±4SD cmH2O P<0.0005), but were normal after LAS. Slow waves were more common in fissure patients (86±6SD% of total recording time vs 68±11SD % of total recording time, P<0.0002), but also became normal after successful treatment. The presence of ultra slow waves was also more common in fissure patients (P<0.0001), and although it was significantly reduced postoperatively (P<0.0001), it did not return to normal. Sampling was less frequent in fissure patients (P<0.0001) and improved significantly after successful treatment (P<0.0002). Rectal distension produced significantly less reduction in anal pressure in fissure patients as compared to controls (P<0.01), but successful treatment returned the response to normal. There were 2 patients with anal fissure who did not heal after left LAS. Those patients and a further 5 patients with non healed fissures after left LAS showed the same pathological manometric features as before surgery. Their fissures were successfully treated by additional right lateral internal sphincterotomy. In conclusion, increased internal sphincter activity is probably an aetiological factor in fissure-in-ano, while successful LAS improves anal sphincter function. Fissures which fail to heal after LAS, can be successfully treated by additional right internal sphincterotomy.
Résumé
L'aspect moteur du sphincter anal interne a été estimé manométriquement chez 42 patients qui avaient une fissure anale avant et après sphinctérotomie latérale interne gauche (LAS). Les pressions de repos et les pressions durant l'effort de retenue étaient significativement plus hautes chez les patients que chez les contrôles (132±21 SD cmH2O vs 81±14SD cmH2O, p<0.0002 and 46±16SD cmH2O vs 13±4SD cmH2O p<0.0005), mais étaient normales après LAS. Des ondes lentes étaient plus communes chez les patients présentant une fissure (86±6SD % vs 68±11SD % du temps total d'enregistrement, p<0.0002), mais se normalisaient aussi après traitement efficace. La présence d'ondes ultralentes étaient aussi plus commune chez les patients présentant une fissure (p<0.0001) et de même étaient significativement réduites en post-opératoire (p<0.0001), mais ne retournaient pas à la normale. Le réflexe d'échantillonage était moins fréquent chez les malades avec fissure (p<0.0001) et s'améliorait significativement après traitement efficace (p<0.0002). La distension rectale produisait significativement moins de réduction de pression anale chez les patients avec fissure comparée aux contrôles (p<0.01), mais après traitement efficace la réponse retournait à la normale. Deux patients avec fissure anale n'ont pas cicatrisé après LAS gauche. Ces patients et 5 autres malades avec fissure non cicatrisée après LAS gauche montraient le même aspect manométrique pathologique qu'avant la chirurgie. Leurs fissures ont été traitées avec succès par une sphinctérotomie latérale interne droite. En conclusion, l'activité augmentée du sphincter anal interne est probablement un facteur étiologique de la fissure anale puisque la sphinctérotomie latérale interne améliore la fonction sphinctérienne anale. Des fissures qui ne cicatrisent pas, après LAS gauche, peuvent être successivement traitées par une sphinctérotomie interne droite additionnelle.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Nothmann BJ, Schuster MM (1974) Internal anal sphincter derangement with anal fissures. Gastroenterology 67:216–230
Arabi Y, Alexander-Williams J, Keighly MRB (1977) Anal pressures in haemorrhoids and anal fissure. Am J Surg 134:608–610
Hancock BD (1977) The internal sphincter and anal fissure. Br J Surg 64:92–95
Gibbons CP, Read NW (1986) Anal hypertonia in anal fissures: cause or effect? Br J Surg 73:443–445
Olsen J, Mortensen PE, Krogh Petersen I, Christiansen J (1987) Anal sphincter function after treatment of fissure-in-ano by lateral subcutaneous sphincterotomy. A randomized study. Int J Colorect Dis 2:155–157
Graham-Stewart CW, Greenwood RK, Lloyd-Davis RW (1961) A review of 50 patients with fissure in ano. Surg Gynecol Obstet 113:445–448
Duthie HL, Bennett RC (1964) Anal sphincteric pressure in fissure in ano. Surg Gynecol Obstet 119:19–21
Abcarian H, Lakeshmanan S, Read DR, Roccaforte P (1982) The role of internal sphincter in chronic anal fissures. Dis Colon Rectum 25:525–528
Notaras MJ (1971) The treatment of anal fissure by lateral subcutaneous internal sphincterotomy — a technique and results. Br J Surg 58:96–100
Marby M, Alexander-Williams J, Buchmann P, Arabi Y, Kappas A, Minervini S, Gatehouse D, Keighly MRB (1979) A randomized controlled trial to compare anal dilatation with lateral subcutaneous sphincterotomy for anal fissure. Dis Colon Rectum 22:308–311
Motson RW, Clifton MA (1985) Pathogenesis and treatment of anal fissure. In: Henry MM; Swash M (eds). Coloproctology and the Pelvic Floor: Pathophysiology and Management. Butterworths London, pp 340–349
Sun WM, Read NW, Miner PB, Kerrigan DD, Donnelly TC (1990) The role of transient internal relaxation in faecal incontinence? Int J Colorect Dis 5:31–36
Bartolo DCC, Read NW, Jarratt JA, Read MG, Donnelly TC, Johnson AG (1983) Differences in anal sphincter function and clincial presentation in patients with pelvic floor descent. Gastroenterology 85:68–75
Parks AG (1967) The management of fissure-in-ano. Br J Hosp Med 1:737–739
Read NW, Bannister JJ (1985) Anorectal manometry: Techniques in health and disease. In: Henry MM, Swash M (eds) Coloproctology and the Pelvic Floor: Pathophysiology and Management. Butterworths London, pp 65–87
Hoffman DC, Goligher JC (1970) Lateral subcutaneous internal sphincterotomy in treatment of anal fissure. Br Med J 3:673–675
Bailey RV, Rubin RJ, Salvati EP (1978) Lateral internal sphincterotomy. Dis Colon Rectum 21:584–586
Ravikumar TS, Sridhar S, Rao RN (1982) Subcutaneous internal sphincterotomy for chronic fissure in ano. Dis Colon Rectum 25:778–801
Boulos PB, Araujo JGC (1984) Adequate internal sphincterotomy for chronic anal fissure: subcutaneous or open technique. Br J Surg 71:360–362
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Xynos, E., Tzortzinis, A., Chrysos, E. et al. Anal manometry in patients with fissure-in-ano before and after internal sphincterotomy. Int J Colorect Dis 8, 125–128 (1993). https://doi.org/10.1007/BF00341183
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00341183