title: Anal endosonographic evaluation after closed lateral subcutaneous sphincterotomy.
abstract: OBJECTIVE
  The present study was undertaken to evaluate anal endosonographic results of the transverse and longitudinal extent of internal anal sphincter division after closed lateral subcutaneous sphincterotomy and its relationship to outcome with respect to anal fissure recurrence and postoperative anal incontinence.
  
  
  METHODS
  Ten patients selected for symptomatic anal fissure recurrence (mean follow-up, 10.9 months) and 41 asymptomatic control patients (mean follow-up, 15.5 months) were reviewed by anal endosonography after closed lateral subcutaneous sphincterotomy. Clinical evaluation was focused on anal fissure recurrence and postoperative anal incontinence. The anal endosonographic study involves serial radial images of the distal, proximal, and midanal canal.
  
  
  RESULTS
  In 32 patients in whom a complete internal sphincter defect was identified, 31 (75.6 percent) were from the control group and only 1 patient (10 percent) was from the recurrence group (P < 0.001). In 19 patients, an incomplete internal sphincter defect was identified; 10 (24.4 percent) were from the control group (residual median size, 1.8 mm; contralateral, 2.5 mm) and 9 patients (90 percent) were from the recurrence group (P = 0.001; residual median size, 1.4 mm; contralateral, 2.2 mm). Ten patients (19.6 percent) were incontinent for gas and three patients (5.9 percent) for liquid feces, without significant differences between groups.
  
  
  CONCLUSIONS
  Anal endosonography is a useful method for evaluating the anatomic effectiveness of closed lateral subcutaneous sphincterotomy. An incomplete sphincterotomy is associated with significant symptomatic anal fissure recurrence.
authors.affiliation: Department of General Surgery, Hospital Clínico Universitario, University of Valencia, Spain.
authors.forename: E
authors.initials: E
authors.lastname: García-Granero
authors.forename: A
authors.initials: A
authors.lastname: Sanahuja
authors.forename: J
authors.initials: J
authors.lastname: García-Armengol
authors.forename: E
authors.initials: E
authors.lastname: Jiménez
authors.forename: P
authors.initials: P
authors.lastname: Esclapez
authors.forename: M
authors.initials: M
authors.lastname: Mínguez
authors.forename: A
authors.initials: A
authors.lastname: Espí
authors.forename: F
authors.initials: F
authors.lastname: López
authors.forename: S
authors.initials: S
authors.lastname: Lledó
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000000981:diagnostic imaging* / Q000601:surgery; D019160:Endosonography; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D005401:Fissure in Ano / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome