Comparative study between open vs closed methods of partial division of puborectalis in treating patients with anismus

ABSTRACT

To revive the results of partial division of the puborectalis and to compare the efficacy of open and a newly designed closed method in treatment of anismus. This prospective randomized study included 30 patients. They were 29 males and one female, with a mean age 42.30 +/- 13.01 years. Diagnosis was made by clinical examination, barium enema, colonoscopy, colonic transit time, anorectal manometry, balloon expulsion test, defecography, and EMG. Patients were randomized into Group [I] included 15 patients who underwent bilateral open division of the puborectalis and group [II] included 15 patients who underwent bilateral closed method. Follow up was conducted for about one year. Improvement was considered when patients returned to their normal habits. Both open and closed methods significantly reduced the preoperative constipation scores. There was 100% initial success. Long term success existed only in 66.6% and 53.3% in group [I] and [II] respectively with no significant difference between the two methods [chi 20.556-P 0.456]. Recurrence was observed in 5 and 7 patients following open and closed methods respectively. Minor degrees of incontinence were confronted in 13.3% in each group with no significant difference. Bilateral partial; division of puborectalis was found to be an effective method in treatment of anismus. Moreover, closed method seems to be simple and attractive