Subcutaneous Fissurotomy: A Novel Procedure for Chronic Fissure-in-ano. A Review of 109 Cases

Abstract

Laying open the subcutaneous tract has a very high success rate and a low incidence of repeat surgery. This finding introduces a new debate relating to the etiology of fissure-in-ano and makes routine internal sphincterotomy unnecessary.

A review of chronic anal fissure management

“…Recently, a fissurotomy has been described that involves deroofing a narrow subcutaneous tract found caudal to the fissure [90]. Of 109 patients who underwent the procedure, 98.2% required no further treatment (median follow-up, 12 months).…”

Comparison Between Lateral Internal Anal Sphincterotomy and Diltiazem in the Treatment of Chronic Anal Fissure

“…3 Surgical methods most commonly employed are finger dilatation and lateral internal sphincterotomy with later been regarded as the gold standard. 3 Other surgical methods developed include fissurectomy and fissurotomy procedures, 7,8 local flap procedures such as V-Y advancement flaps and rotation flaps, 9,10 and sphincterolysis. 11 Calcium channel blockers act by blocking the slow L-type channels causing smooth muscle relaxation thereby decreasing resting anal pressure.…”

Fissurectomy combined with anoplasty and injection of botulinum toxin in treatment of anterior chronic anal fissure with hypertonia of internal anal sphincter: a pilot study

“…Recently, Pelta et al [24] have described a subcutaneous fissurotomy that involves de-roofing a narrow subcutaneous tract found caudal to the fissure and have reported a very high success rate and a low incidence of repeated surgery [24]. Fissurectomy is the excision of the anal fissure and it can be associated with the removal of the hypertrophied anal papilla and the skin tags.…”