Subcutaneous fissurotomy: a novel procedure for chronic fissure-in-ano. a review of 109 cases.

Purpose: The constant presence of a narrow subcutaneous tract extending caudad to chronic fissures-in-ano is reported. The efficacy of surgically unroofing this tract (subcutaneous fissurotomy) without sphincterotomy was evaluated.

Methods: By using a narrow-gauge, hooked probe, a constant, midline subcutaneous tract was identified extending from the caudad aspect of chronic anal fissures.

Combined colonoscopy and three-quadrant hemorrhoidal ligation: 500 consecutive cases.

Purpose: This study was designed to evaluate the safety and efficacy of combining outpatient colonoscopy with simultaneous three-quadrant hemorrhoidal ligation in patients with symptomatic internal hemorrhoidal disease.

Methods: A four-year analysis of patients undergoing combined colonoscopy and synchronous three-quadrant hemorrhoidal ligation was performed. Indications for the procedure were patients with symptomatic internal hemorrhoids who had failed conservative management and who also required colonoscopy.