Closed anal sphincter manipulation technique for chronic anal fissure: P164

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Aim:Wepropose a technique of finger fragmentation of the internal anal sphincter fibres termed ‘Sphincterolysis’ to relieve anal sphincter spasm in patients of chronic anal fissure.Method:Three hundred and one patients with chronic anal fissures treated with this technique were enrolled for the study. Preoperative and postoperative anal manometry was recorded. An independent observer assessed the postoperative course, early and 24-month follow-up results.Results:Fissure healing and relief of symptoms was observed in 97% of patients at 4 weeks. Complications included ecchymosis, hematoma and submucous abscess. 284 patients achieved complete healing within 4 weeks. The remaining 17 needed 4 more weeks for the fissures to heal. Mean resting sphincterpressure before theprocedure was 89.5 mmHg, compared with 47.3 ± 4.3 at 6-months (P < 0.001). Two patients had persisting incontinence to flatus.Conclusion:Digital manipulation of the internal anal sphincter is an easy, safe and effectiveprocedure for the treatment of chronic anal fissure.

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