Evaluation of the extent of lateral internal sphincterotomy using three dimensional endoanal endosonography. Correlation of ultrasonographic with intraoperative findings: LTP85


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Abstract

Aim:To evaluate the extent of lateral internal sphincterotomy (LIS) by three dimensional endosonography (3D-EAUS) and correlate this with intraoperative findings.Method:Patients diagnosed with chronic anal fissure who underwent LIS from December 2008 to August 2009 were included in thisprospective, consecutive study within a specialized Colorectal Unit. A full thickness, short, open LIS was performed and the length measured intraoperatively with a ruler. 3D-EAUS was performed 8 weeks postoperatively. Length of the internal anal sphincter (IAS) and LIS were measured on coronal sections and % of IAS length divided was calculated and correlated with surgical measurements.Results:Thirty-one patients (mean age ± 1SD, 50.77 ± 13.4 years) were included. The median intraoperative length of LIS was 7 mm (4-10), and 8.5 mm (3-22) by 3D-EAUS. The mean % of IAS divided by 3D-US was 32.86. There was a statistically significant correlation between the length of LIS measured intraoperatively and by 3D-EAUS as shown by Spearman's correlation (P = 0.025)Conclusion:There is a good correlation between intraoperative and 3D-EAUS measurement of LIS. This could be useful for assessing the extent of LIS and a valuable tool for assessing the adequacy of surgery in patients with post-LIS fissure recurrence or incontinence.

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