Anal stretch has a higher risk of fissure persistence than internal sphincterotomy and also a significantly higher risk of minor incontinence than sphincterotomy .
The combined results of open versus closed partial lateral internal sphincterotomy show little difference between the two procedures both in fissure persistence and risk of incontinence .
AUTHORS ' CONCLUSIONS Anal stretch and posterior midline internal sphincterotomy should probably be ab and oned in the treatment of chronic anal fissure in adults .
For those patients requiring surgery for anal fissure , open and closed partial lateral internal sphincterotomy appear to be equally efficacious .
BACKGROUND Operative techniques commonly used for fissure in ano include : anal stretch , open lateral sphincterotomy , closed lateral sphincterotomy , posterior midline sphincterotomy and to a lesser extent dermal flap coverage of the fissure .
Reports of direct comparisons between operative techniques for anal fissure are variable in their results .
These reports are either subject to selection bias ( in non-r and omized studies ) or observer bias ( in all studies ) or have inadequate numbers of patients enrolled to answer the question of efficacy .
OBJECTIVES To determine the best technique for fissure surgery .
Extent of Lateral Internal Sphincterotomy: Up to the Dentate Line or Up to the Fissure Apex?
PURPOSE The aim of this r and omized , prospect i ve study was to compare the results of lateral internal sphincterotomy up to the dentate line or up to the fissure apex in the treatment of chronic anal fissure . METHODS Adult patients with chronic anal fissure were r and omly assigned to undergo lateral internal sphincterotomy to the level of the dentate line or to the level of the fissure apex . The patients were reexamined on postoperative Days 1 , 7 , 14 , 28 , and then at 2 and 12 months . RESULTS The time required for relief of pain postoperatively was 2.08 ± 1.44 days in the dentate line group , which was significantly shorter than that for the fissure apex group ( 4.72 ± 4.86 days ; P = 0.002 ) . Objective healing was achieved in 23.7 percent and 17.6 percent at 14 days , 97.4 percent and 88.2 percent at 28 days , and 100 percent and 97.7 percent at 2 months in the dentate line and fissure apex groups , respectively ( P > 0.05 for all comparisons ) . Only sphincterotomy up to the dentate line caused a significant change in anal incontinence ( P = 0.016 ) . Both groups had significantly lower anal resting pressures at 4 months postoperatively , compared with their corresponding preoperative levels ( P = 0.005 and P = 0.007 ) . The postoperative resting pressures did not differ significantly between the two groups ( P = 0.273 ) . By 12 months postoperatively , no treatment failures or recurrences were noted in the dentate line group ( 100 percent healing rate ) . In the fissure apex group , there was one nonhealing case and four recurrences , result ing in a 13.2 percent rate of treatment failure ( P = 0.058 ) . CONCLUSIONS Sphincterotomy up to the dentate line provided a faster and definitive healing within the time limits of this study , but it was associated with a significant alteration in anal continence . In turn , sphincterotomy up to the fissure apex was free of significant disturbance of continence , but its healing effect was slower and it was prone to an insignificantly higher rate of treatment failure
Anal stretch has a higher risk of fissure persistence than internal sphincterotomy and also a significantly higher risk of minor incontinence than sphincterotomy .
The combined results of open versus closed partial lateral internal sphincterotomy show little difference between the two procedures both in fissure persistence and risk of incontinence .
AUTHORS ' CONCLUSIONS Anal stretch and posterior midline internal sphincterotomy should probably be ab and oned in the treatment of chronic anal fissure in adults .
For those patients requiring surgery for anal fissure , open and closed partial lateral internal sphincterotomy appear to be equally efficacious .
BACKGROUND Operative techniques commonly used for fissure in ano include : anal stretch , open lateral sphincterotomy , closed lateral sphincterotomy , posterior midline sphincterotomy and to a lesser extent dermal flap coverage of the fissure .
Reports of direct comparisons between operative techniques for anal fissure are variable in their results .
These reports are either subject to selection bias ( in non-r and omized studies ) or observer bias ( in all studies ) or have inadequate numbers of patients enrolled to answer the question of efficacy .
OBJECTIVES To determine the best technique for fissure surgery .