PURPOSE: Pneumatic balloon dilation has been shown to be effective in the management of chronic anal fissure, but its effect on the anal sphincter has not been fully investigated. The aim of this study was to evaluate prospectively the clinical, anatomic, and functional pattern in a group of patients treated by pneumatic balloon dilation. METHODS: A series of 33 consecutive patients suffering from chronic anal fissure underwent pneumatic balloon dilation. Anal manometry and ultrasonography were performed prior to and 6 to 12 months after the treatment. Manometry was accomplished by means of an endoanal 40-mm balloon inflated with a pressure of 1.4 atmospheres that was left in situ for six minutes under local anesthesia. All patients were interviewed daily for three days after surgery and then clinically evaluated between the third and fifth postoperative weeks. Most patients were interviewed after 25.7 +/- 8.4 months (mean +/- standard deviation). Anal incontinence was evaluated by means of a validated score of 1 to 6. RESULTS: The chronic anal fissure healed between the third and fifth weeks in 31 patients (94 percent), who became asymptomatic 2.5 +/- 1.4 days after pneumatic balloon dilation. None of them reported anal pain two years after the treatment (n = 20). The first post-pneumatic balloon dilation defecation was painless in 27 cases (82 percent). Two multiparous females (6 percent of the patients) complained of minor transient anal incontinence (score, 3). Chronic anal fissure recurred in one case (3 percent) after treatment. At manometry, the preoperative anal resting pressure decreased from 91 +/- 11.2 to 70.5 +/- 5.6 and to 78 +/- 5.7 mmHg, 6 and 12 months after pneumatic balloon dilation, respectively (P < 0.0001). Anal ultrasonography did not show any significant sphincter defect. CONCLUSIONS: Pneumatic balloon dilation seems to be an effective, safe, easy procedure that decreases anal resting pressure without endosonographically detectable significant sphincter damage.
PURPOSE:Pneumatic balloon dilation has been shown to be effective in the management of chronic anal fissure, but its effect on the anal sphincter has not been fully investigated. The aim of this study was to evaluate prospectively the clinical, anatomic, and functional pattern in a group of patients treated by pneumatic balloon dilation. METHODS: A series of 33 consecutive patients suffering from chronic anal fissure underwent pneumatic balloon dilation. Anal manometry and ultrasonography were performed prior to and 6 to 12 months after the treatment. Manometry was accomplished by means of an endoanal 40-mm balloon inflated with a pressure of 1.4 atmospheres that was left in situ for six minutes under local anesthesia. All patients were interviewed daily for three days after surgery and then clinically evaluated between the third and fifth postoperative weeks. Most patients were interviewed after 25.7 +/- 8.4 months (mean +/- standard deviation). Anal incontinence was evaluated by means of a validated score of 1 to 6. RESULTS: The chronic anal fissure healed between the third and fifth weeks in 31 patients (94 percent), who became asymptomatic 2.5 +/- 1.4 days after pneumatic balloon dilation. None of them reported anal pain two years after the treatment (n = 20). The first post-pneumatic balloon dilation defecation was painless in 27 cases (82 percent). Two multiparous females (6 percent of the patients) complained of minor transient anal incontinence (score, 3). Chronic anal fissure recurred in one case (3 percent) after treatment. At manometry, the preoperative anal resting pressure decreased from 91 +/- 11.2 to 70.5 +/- 5.6 and to 78 +/- 5.7 mmHg, 6 and 12 months after pneumatic balloon dilation, respectively (P < 0.0001). Anal ultrasonography did not show any significant sphincter defect. CONCLUSIONS:Pneumatic balloon dilation seems to be an effective, safe, easy procedure that decreases anal resting pressure without endosonographically detectable significant sphincter damage.
Authors: Antonio Tarasconi; Gennaro Perrone; Justin Davies; Raul Coimbra; Ernest Moore; Francesco Azzaroli; Hariscine Abongwa; Belinda De Simone; Gaetano Gallo; Giorgio Rossi; Fikri Abu-Zidan; Vanni Agnoletti; Gianluigi de'Angelis; Nicola de'Angelis; Luca Ansaloni; Gian Luca Baiocchi; Paolo Carcoforo; Marco Ceresoli; Alain Chichom-Mefire; Salomone Di Saverio; Federica Gaiani; Mario Giuffrida; Andreas Hecker; Kenji Inaba; Michael Kelly; Andrew Kirkpatrick; Yoram Kluger; Ari Leppäniemi; Andrey Litvin; Carlos Ordoñez; Vittoria Pattonieri; Andrew Peitzman; Manos Pikoulis; Boris Sakakushev; Massimo Sartelli; Vishal Shelat; Edward Tan; Mario Testini; George Velmahos; Imtiaz Wani; Dieter Weber; Walter Biffl; Federico Coccolini; Fausto Catena Journal: World J Emerg Surg Date: 2021-09-16 Impact factor: 5.469
Authors: Antonio Brillantino; Francesca Iacobellis; Giuseppe Izzo; Natale Di Martino; Roberto Grassi; Adolfo Renzi Journal: Biomed Res Int Date: 2014-06-25 Impact factor: 3.411