DOI: http://dx.doi.org/10.18203/2349-2902.isj20195210

Manual anal dilatation for the treatment of chronic anal fissures: our experience

Mohammed Kashif Habeeb, Mohammed Wasif Habeeb

Abstract


Background: In this study we aim to present our experience in managing chronic anal fissures by manual anal dilatation in order to clarify whether this method is still viable in a modern surgical setup.

Methods: A total of 55 patients who underwent manual anal dilatation for chronic anal fissures from March 2016 till March 2017 were studied prospectively.

Results: 43 of the 55 patients were male and 12 were female (male: female=3.58: 1), aged between 20 to 60 years. The fissure was posterior at 6 o'clock position in 44 patients (80%) and anterior at 12 o'clock position in 8 patients (14.5%). Mean duration of hospital stay was 1.5 days. At the end of 6 weeks post op, only 37 patients (67.3%) were symptom free with the remaining 18 patients (32.7%) having complications. Among the complications, the commonest was ulcer persistence in 12 patients (21.8%). 3 patients had incontinence for flatus (5.5%), 2 had recurrence of ulcer (3.6%) and 1 had incontinence for faeces (1.8%). Mortality was 0%.

Conclusions: Anal fissure is a common benign ano-rectal condition. Once chronicity is established, it is difficult to treat and almost always warrants surgical management. Although manual anal dilatation is a simple and easy procedure, it is associated with significant rates of complication. For long term definitive treatment, manual anal dilatation should be abandoned completely in favour of other surgical techniques like lateral subcutaneous sphincterotomy.


Keywords


Chronic anal fissure, Fissure-in-ano, Manual anal dilatation, Anal stretch, Lord's anal dilatation

Full Text:

PDF

References


Schubert MC, Sridhar S, Schade RR, Wexner SD. What every gastroenterologist needs to know about common anorectal disorders. World J Gastroenterol. 2009;15:3201–9.

Jahnny B, Ashurst JV. Source Stat Pearls. Treasure Island (FL): Stat Pearls Publishing; 2019.

Bhardwaj R, Parker M.C. Modern perspectives in the treatment of chronic anal fissures. Ann R Coll Surg Engl. 2007;89(5):472–8.

Saad AM, Omer A. Surgical treatment of chronic fissure-in-ano: a prospective randomised study. East Afr Med J. 1992;69(11):613-5.

Lord PH. A new regime for the treatment of haemorrhoids. Proc R Soc Med. 1968;61(9):935–6.

Siddiqui J, Fowler GE, Zahid A, Brown K, Young CJ. Treatment of anal fissure: a survey of surgical practice in Australia and New Zealand. Colorectal Dis. 2019;21(2):226-33.

MacDonald A, Smith A, McNeill AD, Finlay IG. Manual dilatation of the anus. Br J Surg.1992;79:1381–2.

Perry WB, Dykes SL, Buie WD, Rafferty JF, Standards Practice Task Force of the American Society of Colon and Rectal Surgeons. Practice parameters for the management of anal fissures (3rd revision). Dis Colon Rectum. 2010;53:1110–5.

Canero A, Consalvo V, Giglio F, D'Auria F, Rescigno C, Vincenzo S. Conservative Management of Chronic Anal Fissure. Results of a Case Series at 2-years Follow-up and Proposition of a New Classification. Surg Technol Int. 2018;33:105-9.

Jensen SL. Treatment of first episodes of acute anal fissure: prospective randomised study of lignocaine ointment versus hydrocortisone ointment or warm sitz baths plus bran. Br Med J (Clin Res Ed). 1986;292:1167–9.

Steele SR, Madoff RD. Systematic review: the treatment of anal fissure. Alimentar Pharmacol Therapeutic. 2006;24(2):247-57.

Marby M, Alexander-Williams J, Buchmann P, Arabi Y, Kappas A, Minervini S, et al. A randomized controlled trial to compare anal dilatation with lateral subcutaneous sphincterotomy for anal fissure. Dis Colon Rectum. 1979;22:308–11.

Giebel GD, Horch R. Treatment of anal fissure: a comparison of three different forms of therapy. Nippon Geka Hokan. 1989;58:126–33.

Madoff RD, Fleshman JW. AGA technical review on the diagnosis and care of patients with anal fissure. Gastroenterol. 2003;124(1):235-45.

Jensen SL, Lund F, Nielsen OV, Tange G. Lateral subcutaneous sphincterotomy versus anal dilatation in the treatment of fissure in ano in outpatients: a prospective randomised study. BMJ (Clin Res Ed). 1984;289:528–30.

Hawley PR. The treatment of chronic fissure-in-ano: a trial of methods. Br J Surg. 1969;56:915.

Isbister WH, Prasad J. Fissure-in-Ano. Aust N Z J Surg. 1995;65(2):107–8.

Graham Stewart CW, Greenwood RK, Llyod-Dawis RW. A review of 50 patients with fissure in ano. Surg Gynecol Obstet. 1961;113:445–8.

Watts JM, Bennett RC, Goligher JC. Stretching of anal sphincters in treatment of fissure-in-ano. Br Med J. 1964;2:342-3.

Speakman CT, Burnett SJ, Kamm MA, Bartram CI. Sphincter injury after anal dilatation demonstrated by anal endosonography. Br J Surg. 1991;78:1429–30.

Nielsen MB, Rasmussen OO, Pedersen JF, Christiansen J. Risk of sphincter damage and anal incontinence after anal dilatation for fissure-in-ano. An endosonographic study. Dis Colon Rectum. 1993;36:677-80.

Ebinger SM, Hardt J, Warschkow R, Schmied BM, Herold A, Post S, et al. Operative and medical treatment of chronic anal fissures-a review and network meta-analysis of randomized controlled trials. J Gastroenterol. 2017;52(6):663-76.

Notaras MJ. Lateral subcutaneous sphincterotomy for anal fissure. A new technique. Proc R Soc Med. 1969;62:713.