Long-term Efficacy and Safety of Controlled Manual Anal Dilatation in the Treatment of Chronic Anal Fissures: A Single-center Observational Study.
anal dilatation
anal fissure
anal sphincter
anal stretching
fecal incontinence
lateral internal sphincterotomy
Journal
Journal of the anus, rectum and colon
ISSN: 2432-3853
Titre abrégé: J Anus Rectum Colon
Pays: Japan
ID NLM: 101718055
Informations de publication
Date de publication:
2023
2023
Historique:
received:
14
04
2023
accepted:
02
06
2023
medline:
30
10
2023
pubmed:
30
10
2023
entrez:
30
10
2023
Statut:
epublish
Résumé
Conventional anal dilatation for anal fissures has long been abandoned because of the high incidence of anal incontinence. However, less invasive and more precise dilation techniques have been developed that have shown high healing and low incontinence rates. This study aimed to evaluate the efficacy and safety of controlled anal dilatation (CAD) using a standardized maximum anal diameter. This study included 523 patients who underwent CAD for chronic anal fissures between January 2010 and December 2014. CAD was performed under sacral epidural anesthesia. The index fingers of both hands were placed in the anus and dilated evenly in various directions. CAD was completed when the anus was dilated to the sixth scale (35 mm in diameter) using a caliber ruler. The mean anal scale size expanded from 3.1 to 5.8 (p<0.001). Non-healing was observed in nine patients (1.7%) at 1 month postoperatively, six of whom underwent additional CAD. The mean maximal anal resting pressure (mmHg) decreased from 90.2 to 79.7 at three months postoperatively (p<0.001). Postoperative complications were observed in 11 (2.1%) patients, of whom three patients with thrombosed hemorrhoids underwent resection. None of the patients complained of anal incontinence during the mean follow-up period of 16.6 months. The cumulative recurrence-free rates at three and five years were 87.9% and 69.2%, respectively. CAD is technically simple and safe and can achieve reasonable long-term outcomes. Thus, CAD appears to be the preferred procedure for patients with chronic anal fissures who do not respond to conservative treatments.
Identifiants
pubmed: 37900697
doi: 10.23922/jarc.2023-019
pmc: PMC10600265
doi:
Types de publication
Journal Article
Langues
eng
Pagination
250-257Informations de copyright
Copyright © 2023 The Japan Society of Coloproctology.
Déclaration de conflit d'intérêts
Conflicts of Interest There are no conflicts of interest.
Références
Dis Colon Rectum. 2023 Feb 1;66(2):190-199
pubmed: 36321851
Colorectal Dis. 2013 Mar;15(3):e104-17
pubmed: 23320551
Dis Colon Rectum. 1993 Jul;36(7):677-80
pubmed: 8348852
Dis Colon Rectum. 2005 Jan;48(1):121-6
pubmed: 15690668
Dis Colon Rectum. 1992 Apr;35(4):322-7
pubmed: 1582352
Tech Coloproctol. 2004 Aug;8(2):89-92; discussion 92-3
pubmed: 15309644
Cochrane Database Syst Rev. 2005 Apr 18;(2):CD002199
pubmed: 15846630
J Anus Rectum Colon. 2022 Jul 28;6(3):150-158
pubmed: 35979269
Dis Colon Rectum. 2008 Jan;51(1):121-7
pubmed: 18080713
Rev Esp Enferm Dig. 2010 Dec;102(12):691-7
pubmed: 21198310
Dis Colon Rectum. 1985 Nov;28(11):832-5
pubmed: 4053894
Int J Surg. 2009 Jun;7(3):228-31
pubmed: 19361582
Br J Surg. 1999 May;86(5):651-5
pubmed: 10361188
Dis Colon Rectum. 2005 Feb;48(2):365-70
pubmed: 15711861
Dis Colon Rectum. 2000 Apr;43(4):503-6
pubmed: 10789746
Proc R Soc Med. 1968 Sep;61(9):935-6
pubmed: 5679021
World J Surg. 2007 Oct;31(10):2052-7
pubmed: 17665247
Clin Colon Rectal Surg. 2016 Mar;29(1):30-7
pubmed: 26929749
Ann Coloproctol. 2021 Oct;37(5):275-280
pubmed: 34246204
Surgery. 2022 Jul;172(1):41-52
pubmed: 34998619
Dis Colon Rectum. 2008 Jan;51(1):128-33
pubmed: 18085337
J Gastroenterol. 2017 Jun;52(6):663-676
pubmed: 28396998
Br Med J. 1964 Aug 8;2(5405):342-3
pubmed: 14162964