Сontrolled circular dilatation and lateral subcutaneous sphincterotomy for chronic anal fissures associated with hemorrhoids III-IV

AIM: to evaluate the results of treatment of chronic anal fissure in combination with grade 3–4 hemorrhoids. PATIENTS AND METHODS: the prospective randomized study included 94 patients with chronic anal fissure in combination with grade 3–4 hemorrhoids, which had randomized in two groups. Forty-eight patients in the main group underwent controlled circular dilation (CCD) and 46 patients in the control group underwent lateral subcutaneous sphincterotomy (BPS). In both groups, patient underwent chronic anal fissure excision and surgical treatment of hemorrhoids. RESULTS: the postoperative pain in group CCD was significantly lower than in the BPS group during all 7 days after surgery (p = 0.0085; p = 0.0001 — on the second and the 7th days, respectively). On the 7th day after surgery according to the profilometry the CCD method was more effective in liquidation internal sphincter hypertonia (p = 0.01), on the 45th — both methods were comparable (p = 0.27). On the 45th day after the surgery, values of rest intraanal pressure describing of the CCD and BPS methods had a comparable effect on internal anal sphincter function (p = 0.45), as well as the external sphincter (p > 0.05). On the 45th after surgery, the rate of postoperative wounds healing in the BPS group was 100%, in the CCD group — 85.4% (p = 0.02). Perineal hematoma was statistically more common in the BPS group (p = 0.014). In the frequency of the incidence anal incontinence clinical manifestations (AI) on the 45th day, CCD and BPS groups were comparable (p = 0.84). CONCLUSION: CCD and BPS methods of internal anal sphincter hypertonia liquidation are comparable in the effectiveness, the overall incidence of postoperative complications, including temporary AI. The advantages of CCD method are a lesser pain syndrome and a low incidence of perineal hematoma in the near postoperative period.