Hydropneumatic anal dilation in conservative treatment of chronic anal fissure: clinical outcomes and randomized comparison with topical nitroglycerin.
BACKGROUND
The surgical approach in chronic anal fissures (CAF) may, occasionally result in anal incontinence. The aim of this investigation was to study feasibility, effectiveness, and safety of hydropneumatic anal dilation (HAD) in conservative treatment of CAF and to compare it with local nitroglycerin (GTN) treatment.


METHODS
Efficacy of HAD was evaluated in 109 patients (65 male, 44 female; mean age, 53.3 years), following anal dilation using Microvasive Rigiflex instrument (Otw 40 mm). Thereafter, 36 patients were randomly divided into two groups to undergo treatment with 0.25% GTN or HAD.


RESULTS
Recovery rate with HAD was 79.8% after 10 days and 94.5% after 30 days. An immediate (within 24 hours) drop was observed in the level of pain; no significant complications or recurrence were reported within 2 years. Healing rate was 94.5% following HAD vs. 38.9% after GTN.


CONCLUSIONS
HAD should be considered a new safe option in CAF treatment.
Gastroenterology Unit, S. Camillo Hospital, Viale J.F. Kennedy, I-02100 Rieti, Italy. sanboschetto@libero.it
S
S
Boschetto
M
M
Giovannone
M
M
Tosoni
F
F
Barberani
D000287:Administration, Topical; D002404:Catheterization / Q000379:methods*; D002908:Chronic Disease; D005240:Feasibility Studies; D005260:Female; D005401:Fissure in Ano / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D005996:Nitroglycerin / Q000008:administration & dosage*; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage*
D014665:Vasodilator Agents; D005996:Nitroglycerin