Summary
A double-blind, randomized, controlled trial in the treatment of primary chronic fissure-in-ano by digital stretching of the anal canal or by a modified lateral subcutaneous sphincterotomy is reported. Whereas there was no difference in the postoperative course of both groups, by checking 65 of 66 patients 6 months postoperatively, we found significantly more lacks of continence after stretching. There was no difference regarding recurrence rate. Pressure monitoring of the anal canal showed significantly higher values at rest in both groups before operation. No correlation between results of monitoring anal pressure and defects of anal continence has been seen.
These results point out that in treatment of primary chronic fissure-in-ano the Lateral subcutaneous sphincterotomy is superior to anal dilatation regarding postoperative defects of anal continence. The recurrence rate in the present study does not force to prefer one of these two methods. Manometric investigations show that the resting pressure in anal canal seems to be elevated in primary chronic fissurein-ano.
Zusammenfassung
Es wird über eine kontrollierte, randomisierte Doppelblindstudie bei der Behandlung der primär-chronischen Analfissur mit der digitalen Dehnung des Analkanales und einer Modifikation der lateralen, subcutanen Sphincterotomie nach Notaras berichtet. Während sich im postoperativen Verlauf kein Unterschied zwischen den beiden Behandlungsgruppen ergab, fanden wir bei der Kontrolluntersuchung von 65 der 66 operierten Patienten nach der Sphincterdehnung signifikant mehr Kontinenzstörungen. Die Rezidivquote in den beiden Behandlungsgruppen war gleich. Manometrische Untersuchungen ergaben bei beiden Behandlungsgruppen präoperativ signifikant höhere Ruhedruckmaxima. Eine Korrelation zwischen manometrischen Befunden und Kontinenzstörungen ließ sich nicht herstellen. Die vorliegenden Ergebnisse zeigen, daß die laterale, subcutane Sphincterotomie bei der Behandlung der primärchronischen Analfissur bezüglich der postoperativen Kontinenzstörungen der digitalen Dehnung überlegen ist. In der vorliegenden Studie favorisiert die Rezidivquote keine der beiden Behandlungsmethoden. Manometrische Untersuchungen des Ruhedrucks im Analkanal scheinen darauf hinzuweisen, daß dieser bei der primär-chronischen Analfissur erhöht ist.
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Fischer, M., Thermann, M., Trobisch, M. et al. Die Behandlung der primär-chronischen Analfissur durch Dehnung des Analkanales oder Sphincterotomie. Langenbecks Arch Chiv 343, 35–44 (1976). https://doi.org/10.1007/BF01261568
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DOI: https://doi.org/10.1007/BF01261568