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 .
Open versus closed lateral sphincterotomy performed as an outpatient procedure under local anesthesia for chronic anal fissure: prospective randomized study of clinical and manometric longterm results.
BACKGROUND The aim of this prospect i ve r and omized trial was to compare the effectiveness and morbidity of open and closed sphincterotomy performed as an outpatient procedure under local anesthesia in the treatment of chronic anal fissure . STUDY DESIGN Eighty patients with chronic anal fissure were treated by open  ( group 1 ) or closed lateral internal sphincterotomy ( group 2 ) . Clinical and manometric results were recorded at the time of admission and at 1-week , 2-month , 6-month , 1-year , and 2-year followup visits . RESULTS Overall healing after 2 years was 92.5 % in the open sphincterotomy group and 90 % in the closed sphincterotomy group ( p > 0.05 ) . Fissures were notably less likely to heal in patients in whom the condition had been present for longer than 12 months and who had a sentinel pile before treatment . At the 2-year revision , incontinence was present in two patients ( 5 % ) in the open sphincterotomy group and one patient ( 2.5 % ) in the closed sphincterotomy group ( p > 0.05 ) . In all cases , the incontinence was mild ( < 4 , Clevel and score ) . Increased mean resting pressure ( 113.9 mmHg ) was found in patients with anal fissure before treatment compared with the healthy control group ( mean resting pressure = 66 mmHg ) ( p < 0.001 ) . The mean resting pressure in patients cured after 2 years was 75.65 mmHg , and in those with a recurrent fissure was 112.85 mmHg ( p < 0.001 ) . CONCLUSIONS Morbidity and recurrence were similar in open and closed sphincterotomies when the procedures were performed under local anesthetic , and sphincterotomy under local anesthesia as an outpatient procedure has several socioeconomic advantages ( high degree of satisfaction and comfort to the patient , rapid solution of the problem , and no admission to the hospital or an operating room and no preoperative studies )
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 .