Closed anal sphincter manipulation technique for chronic anal fissure.

BACKGROUND The author describes a technique of closed manipulation of the fibers of the internal anal sphincter to relieve anal spasm in patients with chronic anal fissures. PATIENTS AND METHODS 301 patients with chronic anal fissures treated with this technique were enrolled for the study. Preoperative and postoperative anal manometry was recorded. An independent observer assessed postoperative course and early and 24-month follow-up results. RESULTS Fissure healing and relief of symptoms was observed in 97% of patients at the first follow-up at 4 week. The notable complications included ecchymosis, hematoma and submucus abscess. 284 patients achieved complete healing within 4 weeks. The remaining 17 needed 4 more weeks for the fissures to heal. Mean resting pressure before the procedure was 89.5 mmHg and it was recorded as 47.3 +/- 4.3 at 6-month follow-up [p < 0.001). Two of the patients had persisting complaint of incontinence to flatus. CONCLUSION Manipulation of internal anal sphincter is an easy, safe and effective procedure for the treatment of chronic anal fissure.