The Effect Of Lateral Sphincterotomy On The Anal Sphincter Complex In Chronic Anal Fissure Assesed By Perioperative Transperineal Ultrasonography

Hany M. El Hennawy, Wake Forest University Medical Center, Winston-Salem, North Carolina, United States of America
Elsaid M.A. Bedair, Department of Radiology, Al Khor Hospital, Hamad Medical Corporation, Qatar
Ahmed Abdu Moustafa, Department of Surgery, Faculty of Medicine for Girls, Al Azhar University, Egypt
Gad Youssef Meki, Department of Surgery, Faculty of Medicine for Girls, Al Azhar University, Egypt
Bosat Elwany Bosat, Department of Surgery, Faculty of Medicine for Girls, Al Azhar University, Egypt

Abstract

Transperineal ultrasonography has not been previously utilized in the evaluation of the anal sphincter in patients with chronic anal fissure.

Objective: To assess the morphological and pathological effects of lateral internal sphincterotomy on anal sphincter complex using transperineal ultrasonography. Method: A prospective case series of 50 consecutive patients presented to the colorectal clinic, between January 2012 and June 2013. Patients were not excluded for age or sex. Preoperative transperineal ultrasonography was performed within 14 days of the planned date of surgery. Postoperative transperineal ultrasonography was performed four to six months postoperatively).

Results: Postoperative external anal sphincter changes included; thinning in 9 patients (5 nonspecific thinning and 4 thinning opposite to the site of the internal anal sphincter defect), 2 evolving fistulae, 6 granulomatous reactions within or adjacent to the external anal sphincter, poor recognition of both sphincters in 3 patients, defect of both sphincters at same area with hypertrophy of other parts in 6 patients, thinning of both sphincters at same area in 4 patients and granulomatous changes related to both sphincters in 3 patients. Conclusion: Sphincterotomy induces significant diffuse thinning of both sphincters at all levels of anal canal. Preoperative occult external anal sphincter defects had no postoperative clinical significance. While transperineal ultrasonography is a feasible and convenient technique, further studies of its role are recommended.

Recommended Citation

Hany M. El Hennawy, Elsaid M.A. Bedair, Ahmed Abdu Moustafa, Gad Youssef Meki, and Bosat Elwany Bosat (2015) "The Effect Of Lateral Sphincterotomy On The Anal Sphincter Complex In Chronic Anal Fissure Assesed By Perioperative Transperineal Ultrasonography," World Journal of Colorectal Surgery: Vol. 5 : Iss. 1, Article 4.
Available at: http://services.bepress.com/wjcs/vol5/iss1/art4

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ISSN: 1941-8213

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