Posting what I gleaned, as adding to this posting by
wecc seems to be the best place.
I can understand that LIS is the surgery of choice, but for others (like me - older and with a lot of scar tissue in the region), other less 'radical' options do appeal.
1. and 2. are randomized Trials for Controlled Anal Dilation dated 2009 and 2010.
Also here is a link to 'Operative procedures for fissure in ano.' Note the final comment in the MAIN RESULT of this study to be found at:
http://www.ncbi.nlm.nih.gov/pubmed/22071803 Randomized Trials for Controlled Anal Dilation:
1. Yucel T, Gonullu D, Oncu M, Koksoy FN, Ozkan SG, Aycan O:
Comparison of controlled-intermittent anal dilatation and lateral internal sphincterotomy in the treatment of chronic anal fissures: a prospective, randomized study. Int J Surg; 2009 Jun
* [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
* [Title] Comparison of controlled-intermittent anal dilatation and lateral internal sphincterotomy in the treatment of chronic anal fissures: a prospective, randomized study.
* AIM: The results of controlled-intermittent anal dilatation (CIAD) or lateral internal sphincterotomy (LIS) in the treatment of chronic anal fissures are presented.
* The pre- and post-operative mean anal canal resting pressures (MACRPs) and symptoms were recorded and the results were compared.
* RESULTS: Two months post-operatively, 18 patients in the CIAD group and 17 patients in the LIS group had healed completely, and had no anal incontinence or other complications.
* No statistical difference existed in the pre- or post-treatment MACRPs between the groups.
* CONCLUSION: CIAD applied with a standardized technique reduced anal canal resting pressure and provided symptomatic healing that was equivalent to a LIS.
* Since there were no findings of incontinence, or situations which resulted in sphincter damage, we conclude that CIAD is suitable for patients with chronic anal fissures because it is less invasive than LIS, with equivalent efficacy and safety.
* In addition, the CIAD method may be an alternative procedure in older and multiparous women who has a higher risk of incontinence.
* MedlinePlus Health Information. consumer health - Anal Disorders.
* [Affiliation] Sakarya University, Sakarya Medical School, Department of Surgery, Sakarya, Turkey.
* [Journal-full-title] International journal of surgery (London, England)
* [Publication-type] Comparative Study; Journal Article; Randomized Controlled Trial
* [Publication-country] England
1. Santander C, Gisbert JP, Moreno-Otero R, McNicholl AG, Matй J: Usefulness of manometry to select patients with anal fissure for controlled anal dilatation. Rev Esp Enferm Dig; 2010 Dec;102(12):691-7
* [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
* [Title] Usefulness of manometry to select patients with anal fissure for controlled anal dilatation.
* AIM: To evaluate the use of anorectal manometry to select patients for controlled anal dilatation.
* METHODOLOGY: A prospective study was performed using anorectal manometry on all patients with chronic anal fissure who did not have a good response to conservative treatment.
* Those with increased anal resting pressure were treated with controlled anal dilatation using a two valved anuscope.
* A second anorectal manometry was indicated after controlled anal dilatation.
* RESULTS: 19 patients without anorectal pathology (Healthy Control Group) and 57 patients with chronic anal fissure were included in this study.
* Controlled anal dilatation was performed on 27 patients, maximum resting pressure 122 ± 19 mmHg.
* In the controlled anal dilatation group the healing rate was 92.5%, mean maximum resting pressure post-controlled anal dilatation was 91 ± 30 mmHg.
* We found one case of transitory anal incontinence (3.7%).
* None of the patients had anal incontinence at 18 months of the follow-up.
* In the remaining 30 patients non selected for controlled anal dilatation (chronic anal fissure control group), a proportion of 53.3% recurrences were registered after conservative treatment.
* CONCLUSIONS: Anal healing of chronic anal fissure and a significant decrease in maximum resting pressure recorded by manometry confirms the success of this procedure.
* The manometric evaluation of the maximum resting pressure is useful in the selection of chronic anal fissure patients for controlled anal dilatation.
* The efficacy of dilatation to treat chronic anal fissure in patients with raised anal sphincter pressure was high and complications were rare.
* MedlinePlus Health Information. consumer health - Anal Disorders.
* [Affiliation] Department of Gastroenterology and Coloproctology Unit. La Princesa University Hospital. Universidad Autуnoma de Madrid, C/Diego de Leуn 62, Madrid, Spain.
* [Publication-type] Journal Article; Research Support, Non-U.S. Gov't
* [Publication-country] Spain