Erschienen in:
01.01.2008 | Original Contribution
Fine-tuning of the Extent of Lateral Internal Sphincterotomy: Spasm-controlled vs. up to the Fissure Apex
verfasst von:
B. Bülent Menteş, M.D., Melike Karen Güner, M.D., Sezai Leventoglu, M.D., Nusret Akyürek, M.D.
Erschienen in:
Diseases of the Colon & Rectum
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Ausgabe 1/2008
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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.