COMPARATIVE STUDY BETWEEN OPEN VS CLOSED METHODS OF PARTIAL DIVISION OF PUBORECTALIS IN TREATING PATIENTS WITH ANISMUS

Aim: 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. Methods: 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. Results: 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) (II) respectively with no significant difference between the two methods (Χ2:0.556 - 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. Conclusion: 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.