Asian Journal of Surgery

Asian Journal of Surgery

Volume 37, Issue 4, October 2014, Pages 178-183
Asian Journal of Surgery

Original article
Open versus closed lateral internal anal sphincterotomy in the management of chronic anal fissures: A prospective randomized study

https://doi.org/10.1016/j.asjsur.2014.01.009Get rights and content
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Summary

Objective

Chronic anal fissure is a benign disorder that is associated with considerable discomfort. Surgical treatment in the form of lateral sphincterotomy has long been regarded as the gold standard of treatment. This study compared the open and closed techniques of lateral sphincterotomy in terms of their postoperative outcomes.

Methods

A prospective, randomized comparative study was conducted between October 2010 and August 2012. A total of 136 patients were randomly assigned to each of two groups. Patients were followed up postoperatively for more than 1 year to assess any complications. The outcomes were compared among the two groups using the Chi-square test and Student t test.

Results

The mean age at presentation was 40.13 years. The male to female ratio was 1.47:1. The typical presentation was painful defecation. Fissures were most often located in the posterior midline and associated with a sentinel pile. Delayed postoperative healing was found in 4.4% of the group of patients undergoing open lateral sphincterotomy. The mean pain score and duration of hospital stay were lower with the closed technique.

Conclusion

Closed lateral internal sphincterotomy is the treatment of choice for chronic fissures as it is effective, safe, less expensive, and associated with a lower rate of complications than the open sphincterotomy technique.

Keywords

anal bleeding
chronic anal fissures
lateral sphincterotomy
pain

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Conflicts of interest: The authors declare that they have no financial or non-financial conflicts of interest related to the subject matter or materials discussed in the manuscript.