title: Endoanal ultrasonographic evaluation of an unhealed anal fissure after the lateral internal sphincterotomy.
abstract: OBJECTIVE
  The aim of this study was to evaluate the outcomes of the lateral internal sphincterotomy in patients who had unhealed anal fissures using the endoanal ultrasonography.
  
  
  BACKGROUND
  Lateral internal sphincterotomy is an effective method in treatment of chronic anal fissures, but it is associated with 1 to 5 % unhealing and recurrence rates. Endoanal ultrasonography can be used to evaluate the sphincterotomy and the efficiency of the treatment.
  
  
  METHODS
  Totally, 40 patients with unhealed anal fissures after the lateral internal sphincterotomy were enrolled consecutively. The fissures were diagnosed by proctologic examination in every patient. The results of sphincterotomy were evaluated by the endoanal ultrasonography.
  
  
  RESULTS
  There were 23 men and 17 women with the median age 29.7 years (range, 20-44 years). Using the endoanal ultrasonography, an incomplete internal sphincterotomy was detected in 26 of patients. In 12 patients, while the internal sphincter was completely intact, a superficial (subcutaneous) external anal sphincterotomy was found. In two patients, although the internal sphincterotomy was observed to be sufficient, a localized abscess formation of less than 1 cm was detected at the anal crypts level.
  
  
  CONCLUSIONS
  The use of endoanal ultrasonography in patients with unhealed or recurrent anal fissure is a beneficial diagnostic method in assessing the situations of sphincters after the lateral internal sphincterotomy. Although the lateral internal sphincterotomy is a successful surgical treatment and can be performed easily as an outpatient procedure, it should be performed with the correct and rigorously surgical technique (Tab. 2, Fig. 3, Ref. 31).
authors.affiliation: Department of General Surgery, Gulhane Military Medical Academy, Istanbul, Turkey. erguntuna19@yahoo.com
authors.forename: E
authors.initials: E
authors.lastname: Yucel
authors.forename: M L
authors.initials: ML
authors.lastname: Akin
authors.forename: I
authors.initials: I
authors.lastname: Sucullu
authors.forename: A I
authors.initials: AI
authors.lastname: Filiz
authors.forename: Y
authors.initials: Y
authors.lastname: Ozdemir
authors.forename: M
authors.initials: M
authors.lastname: Yildiz
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000000981:diagnostic imaging* / Q000601:surgery; D019160:Endosonography; D005260:Female; D005401:Fissure in Ano / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D008297:Male; D014945:Wound Healing; D055815:Young Adult