Is manometry essential for surgery of chronic fissure-in-ano?
PURPOSE: Although many studies reported the association between high anal sphincter pressures and anal fissures, one question is open to date: is manometry really necessary for surgical management/does manometry influence the outcome? METHODS: Between October 1, 1990 and December 31, 1991, lateral sphincterotomy was performed in 177 patients with chronic anal fissure. In all patients the operation was performed as an outpatient procedure under local anesthetic. Electromanometry of the anal canal was carried out preoperatively to demonstrate the raised resting pressure profile within the anal canal. At the same time the maximum squeezing pressure was determined by electromanometry, and electromyography was performed to detect dysfunction of the external sphincter or the levators. The control group consisted of 14 proctologically healthy patients with a resting pressure of 74.4 +/- 8.9 and a maximum squeezing pressure of 130.2 +/- 15 (cm H2O). On the basis of resting pressures determined
