Manual anal dilatation for the treatment of chronic anal fissures: our experience
Keywords:Chronic anal fissure, Fissure-in-ano, Manual anal dilatation, Anal stretch, Lord's anal dilatation
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.
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