Long-term Efficacy and Safety of Controlled Manual Anal Dilatation in the Treatment of Chronic Anal Fissures: A Single-center Observational Study
Objectives: 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...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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The Japan Society of Coloproctology
2023-10-01
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| Series: | Journal of the Anus, Rectum and Colon |
| Subjects: | |
| Online Access: | https://www.jstage.jst.go.jp/article/jarc/7/4/7_2023-019/_pdf/-char/en |
| _version_ | 1797650431963299840 |
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| author | Tatsuya Abe Masao Kunimoto Yoshikazu Hachiro Shigenori Ota Kei Ohara Mitsuhiro Inagaki Yusuke Saitoh Masanori Murakami |
| author_facet | Tatsuya Abe Masao Kunimoto Yoshikazu Hachiro Shigenori Ota Kei Ohara Mitsuhiro Inagaki Yusuke Saitoh Masanori Murakami |
| author_sort | Tatsuya Abe |
| collection | DOAJ |
| description | Objectives: 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.
Methods: 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.
Results: 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.
Conclusions: 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. |
| first_indexed | 2024-03-11T16:01:19Z |
| format | Article |
| id | doaj.art-b0a4f163bf234b5d81fc442a8c3e64ac |
| institution | Directory Open Access Journal |
| issn | 2432-3853 |
| language | English |
| last_indexed | 2024-03-11T16:01:19Z |
| publishDate | 2023-10-01 |
| publisher | The Japan Society of Coloproctology |
| record_format | Article |
| series | Journal of the Anus, Rectum and Colon |
| spelling | doaj.art-b0a4f163bf234b5d81fc442a8c3e64ac2023-10-25T07:00:35ZengThe Japan Society of ColoproctologyJournal of the Anus, Rectum and Colon2432-38532023-10-017425025710.23922/jarc.2023-0192023-019Long-term Efficacy and Safety of Controlled Manual Anal Dilatation in the Treatment of Chronic Anal Fissures: A Single-center Observational StudyTatsuya Abe0Masao Kunimoto1Yoshikazu Hachiro2Shigenori Ota3Kei Ohara4Mitsuhiro Inagaki5Yusuke Saitoh6Masanori Murakami7Department of Proctology, Kunimoto HospitalDepartment of Proctology, Kunimoto HospitalDepartment of Proctology, Kunimoto HospitalDepartment of Proctology, Kunimoto HospitalDepartment of Proctology, Kunimoto HospitalDepartment of Proctology, Kunimoto HospitalDepartment of Gastroenterology, Kunimoto HospitalDepartment of Gastroenterology, Kunimoto HospitalObjectives: 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. Methods: 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. Results: 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. Conclusions: 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.https://www.jstage.jst.go.jp/article/jarc/7/4/7_2023-019/_pdf/-char/enanal fissureanal dilatationanal stretchinganal sphincterfecal incontinencelateral internal sphincterotomy |
| spellingShingle | Tatsuya Abe Masao Kunimoto Yoshikazu Hachiro Shigenori Ota Kei Ohara Mitsuhiro Inagaki Yusuke Saitoh Masanori Murakami Long-term Efficacy and Safety of Controlled Manual Anal Dilatation in the Treatment of Chronic Anal Fissures: A Single-center Observational Study Journal of the Anus, Rectum and Colon anal fissure anal dilatation anal stretching anal sphincter fecal incontinence lateral internal sphincterotomy |
| title | Long-term Efficacy and Safety of Controlled Manual Anal Dilatation in the Treatment of Chronic Anal Fissures: A Single-center Observational Study |
| title_full | Long-term Efficacy and Safety of Controlled Manual Anal Dilatation in the Treatment of Chronic Anal Fissures: A Single-center Observational Study |
| title_fullStr | Long-term Efficacy and Safety of Controlled Manual Anal Dilatation in the Treatment of Chronic Anal Fissures: A Single-center Observational Study |
| title_full_unstemmed | Long-term Efficacy and Safety of Controlled Manual Anal Dilatation in the Treatment of Chronic Anal Fissures: A Single-center Observational Study |
| title_short | Long-term Efficacy and Safety of Controlled Manual Anal Dilatation in the Treatment of Chronic Anal Fissures: A Single-center Observational Study |
| title_sort | long term efficacy and safety of controlled manual anal dilatation in the treatment of chronic anal fissures a single center observational study |
| topic | anal fissure anal dilatation anal stretching anal sphincter fecal incontinence lateral internal sphincterotomy |
| url | https://www.jstage.jst.go.jp/article/jarc/7/4/7_2023-019/_pdf/-char/en |
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