Avaliação clínica, funcional e morfológica dos pacientes submetidos à esfincterotomia lateral interna por fissura anal crônica

• Autor(a) principal: Fernandes, Graziela Olívia da Silva
• Data de Publicação: 2012
• Tipo de documento: Dissertação
• Idioma: por
• Título da fonte: Repositório Institucional da Universidade Federal do Ceará (UFC)
• Texto Completo: http://www.repositorio.ufc.br/handle/riufc/7328
• topic: Fissura Anal; Manometria; Ultrassonografia

The anal fissure is one of the main diseases found in the offices of colorectal surgeons. The ideal treatment for chronic anal fissure remains uncertain, but, until now, the lateral internal sphincterotomy is still the most effective treatment available. The aim of this study was to evaluate the anatomy and anorectal function of patients undergoing lateral internal sphincterotomy for chronic anal fissure. Also, determine the correlation between fecal incontinence symptoms and the anatomic findings using three-dimensional anorectal ultrasonography to establish the percentage of the internal anal sphincter that could be safely divided during lateral sphincterotomy. In a prospective study, 31 females, mean age 40years, with chronic anal fissure treated with lateral internal sphincterotomy were evaluated using Wexner’s incontinence score, anal manometry and 3D anorectal ultrasonography. It was also included 26 healthy females control, mean age 38years. Anal canal pressures and the muscles length were measured 4 months after surgery and compared between both groups. The longitudinal length and percentage of internal anal sphincter divided in relation to total contralateral sphincter length were assessed and correlated with incontinence score. Student t test, one-way ANOVA, chi square test, Spearman correlation and the intraclass correlation coefficient (ICC) were used. The p <0.05 was the value used for statistical significance. The sphincterotomy group included 11 nulliparous, 11 vaginal delivery and 9 cesarian cessation. The figures for control group were similar. The incontinence score was similar when compared the parity and mode of delivery of the patients. There was no correlation between age and scores of fecal incontinence. The anal resting pressure decreased significantly after surgery. There was no difference between the maximal voluntary pressure in pre-and postoperatively. There was no statistically significant difference in the length of the anterior external anal sphincter, external anal sphincter- puborectalis complex and GAP when compared the patients undergoing sphincterotomy with voluntary patients. There was a statistically significant positive correlation between the length of muscle divided and the score of fecal incontinence. Eighteen patients had less than 25% of the internal anal sphincter divided and the average size of 0,54cm divided sphincter.Thirteen patients had 25% or more of the internal anal sphincter divided and the average size of 1.00 cm divided sphincter. The incontinence score was significantly lower in patients with less than 25% of the internal anal sphincter divided. There was no correlation between the angle of injury and incontinence score. The intra-class correlation coefficient ranged from 0.714 to 0.989 for the ultrasound measurements performed by two examiners. It is concluded that there was a correlation between the size of the internal anal sphincter divided and anal incontinence score and the division of the IAS must be limited to less than 25% of the total length of the muscle.