Chronic fissure-in-ano

Abstract

A prospective study comparing open and subcutaneous lateral internal sphincterotomy for chronic anal fissure was conducted. One hundred twelve patients were randomized to open (n = 54) or subcutaneous (n = 58) sphincterotomy. There was no significant difference in acute complications between the subcutaneous (8.6 percent) and open (7.4 percent) groups. Postoperative length of stay was significantly shorter for the subcutaneous group (1.7 +/- 0.2 days) than for the open group (2.3 +/- 0.1 days; P less than 0.001). Although the response rate to a pain questionnaire was less than 50 percent, the data suggest a lower level of postoperative pain in the subcutaneous group. Fissure healing was similar between the subcutaneous (96.6 percent) and open (94.4 percent) groups. We conclude that subcutaneous lateral internal sphincterotomy for chronic fissure-in-ano is effective and may result in significantly less postoperative discomfort, shorter postoperative lengths of stay, and a comparable rate of complications compared with the open technique.

ACG Clinical Guidelines: Management of Benign Anorectal Disorders

“…It remains the surgical treatment of choice for chronic anal fissures that are refractory to medical treatment (166,167). Healing rates have been reported between 94% and 98% (147,148,168) and are clearly superior to uncontrolled manual anal dilation, with better healing rates and less incontinence (167). It is also more efficacious than any topical (169) or injectable treatment (170).…”

“…It is also more efficacious than any topical (169) or injectable treatment (170). There is no outcome difference between open and closed sphincterotomy, and thus, a minimal-incision approach is probably preferred (148,168,171). However, there is a low but real incidence of FI from LIS (172), and hence, surgeons continue to explore alternative interventions (173,174).…”

The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Anal Fissures

“…Multiple, well-designed comparative studies have demonstrated that there are no significant differences in outcomes between properly performed open and closed surgical sphincterotomies, with healing rates of 90% to 100% and 85% to 100%, respectively, and minor FI rates of 5% to 25% and 2.5% to 25%, respectively. 54,[67][68][69][70] A Cochrane analysis of 5 studies including 336 patients also confirmed this finding, reporting no statistical difference with regard to fissure healing (OR 1.00, 95% CI, 0.40-2.48) and incontinence to flatus (OR 0.87; 95% CI, 0.41-1.83). 54 With regard to postoperative pain and complication rates, a randomized study of 136 patients demonstrated that open sphincterotomy was associated with significantly higher postoperative pain scores and a 4.4% delayed healing rate of the surgical site at 1-year follow-up in the open group, compared to no delayed healing in the closed group (p = 0.08).…”

Idiopathic Hypertensive Anal Canal: A Place of Internal Sphincterotomy

“…26,27 LIS has been proven highly effective in curing anal fissures in a number of randomized clinical trials, with success rates higher than 90%. 13,14,[28][29][30][31] It encompasses an overall risk of incontinence, which can be as high as 10%. 15 Hence, the interest in seeking new medical treatments is directed at lowering the tone of the IAS.…”