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149
Boschetto et al. (2004) carried out IAD with a hydropneumatic system (balloon
filled with water of 38 ° C at a pressure of 1.3 atm for 20 min, and compared the
results with the effect of GTN ointment. Thirty days later, the healing rate after the
use of the pneumatic method was 94.5% and was thus significantly higher than that
of 38.9% after the application of GTN.
Conclusion
Instrumental anal dilatation seems to be a suitable alternative to MAD because of its
high success rates and the low number of complications. Further trials with a higher
number of cases are necessary to achieve convincing results. One disadvantage of
the procedure is that secondary changes are not removed.
11.3.7 Associated Diseases
The experienced proctologist is aware of the frequent association of anal fissure
with hemorrhoidal disease. It is strange that most medical textbooks do not mention
this fact. Only Hansen and Stelzner (1981) say that “one very often finds the simul-
taneous existence of anal fissure and a second degree hemorrhoidal disease.” (trans-
lated from the German original)
Hughes and Cuthbertson (1972) state that “there is no well-defined relationship
between internal hemorrhoids and anal fissure. It is difficult to decide on the fre-
quency of coexistence of these two disorders because normally an anorectal exami-
nation cannot be completely carried out, when an anal fissure is present.”
Examining the relevant medical literature, we found that — depending on the
author — anal fissure patients exhibit a coexistent hemorrhoidal disease in
19.3−93.4% of the cases. Table 11.36 gives the frequency of anal fissure coexistent
with hemorrhoidal disease.
Table 11.36 Anal fissure and coexistent hemorrhoidal disease in 11 trials with 6,477
patients (in %)
Author (year)
Anal fissure patients (n)
With coexistent
hemorrhoidal disease (%)
Dederichs (2000) 93 19.3
Oh et al. (1995) 1,391 24.9
Stürmlinger (1986) 152 35.3
Jost (1989) 75 36.0
Willemsen (1963) 144 36.2
Eißer (1990) 85 40.0
Schanne (1998) 56 46.2
Schwaner (2002) 60 83.0
Mazier (1972) 1,000 86.6
Khubchandani and Reed (1989) 1,057 93.4
Reinhard and Kirsch (1993) 2,364 88.0
Total 6,477
11.3 Surgical Treatment
150
Conclusion
Coexistent hemorrhoidal disease should always be treated together with the anal
fissure.
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