Anal manometric evaluation in anal fissure. Effect of anal dilation and lateral subcutaneous sphincterotomy

Anal manometry was performed in 41 patients with chronic anal fissure in order to detect possible abnormalities of sphincter function. Comparisons were made with controls matched for sex and age. The maximal basal pressure was significantly higher in the patients with anal fissure, but no other abnormality of anal sphincter function was found in these patients. Clinical and manometric results were evaluated after 2 months in 19 patients treated with anal dilation and in 14 with lateral subcutaneous sphincterotomy. After both procedures the basal pressure was significantly reduced, but there were four failures, all after anal dilation. The study supports the view that increased pressure in the anal canal contributes in the pathophysiology of anal fissure. The condition can be managed by anal dilation or lateral subcutaneous sphincterotomy, both of which effectively reduce the basal pressure in the anal canal.