Comparison of Fissurectomy VS Lateral Internal Sphincterotomy in Chronic Anal Fissure Surgery

Abstract

Background: Chronic anal fissure is the most common cause of anal pain associated with internal anal sphincter 
hypertonia. Although lateral internal sphincterotomy (LIS) is an effective treatment of chronic fissure in ano, it has 
the potential to cause serious complications, the most distressing of which is incontinence to flatus and fecal soiling. 
We proposed fissurectomy (F) as an alternative surgical treatment.  
Study Design: Experimental and Comparative Study. 
Place of Study: This study was conducted at Surgical Department, Ghulam Mohammad Mahar Medical  
College Sukkur. 
Patients and Methods: one hundred twenty four patients, divided into two groups. Sixty patients underwent 
fissurectomy and 64 underwent lateral internal sphincterotomy. After a median follow-up of 18 months, we 
compared the results of the two procedures. In addition to frequent visits on a predetermined basis, a telephone 
inquiry into fissure recurrence and continence status was made.  
Results: All patients in either group were pain-free and without bleeding within one week. In both groups, urinary 
retention was noted in two patients. Incontinence to flatus occurred in four patients (6.2%) in the LIS group, but no 
incontinence was noted in the F group. There were two patients (3.1%) with fissure recurrence in the LIS group, but 
no one in F group. No patient in either group was afflicted with anal stenosis or perianal infections. All wounds 
healed within 6 to 8 weeks. 58 patients (96.6%) in the F group and 56 (87.5%) in the LIS group reported satisfactory 
results.  
Conclusion: In surgical treatment of chronic anal fissures not responding to conservative management, fissurectomy 
may be a sphincter-sparing alternative and perhaps a preferable surgical technique.