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 .
Pneumatic Balloon Dilatation for Chronic Anal Fissure: A Prospective, Clinical, Endosonographic, and Manometric Study
PURPOSE Pneumatic balloon dilation has been shown to be effective in the management of  chronic anal fissure  , but its effect on the anal sphincter has not been fully investigated . The aim of this study was to evaluate prospect ively the clinical , anatomic , and functional pattern in a group of patients treated by pneumatic balloon dilation .  METHODS A series of 33 consecutive patients suffering from chronic anal fissure underwent pneumatic balloon dilation .  Anal manometry and ultrasonography were performed prior to and 6 to 12 months after the treatment . Manometry was accomplished by means of an endoanal 40-mm balloon inflated with a pressure of 1.4 atmospheres that was left in situ for six minutes under local anesthesia . All patients were interviewed daily for three days after surgery and then clinical ly evaluated between the third and fifth postoperative weeks . Most patients were interviewed after 25.7 ± 8.4 months ( mean ± st and ard deviation ) . Anal incontinence was evaluated by means of a vali date d score of 1 to 6 . RESULTS The chronic anal fissure healed between the third and fifth weeks in 31 patients ( 94 percent ) , who became asymptomatic 2.5 ± 1.4 days after pneumatic balloon dilation . None of them reported anal pain two years after the treatment ( n = 20 ) . The first post-pneumatic balloon  dilation defecation was painless in 27 cases ( 82 percent ) . Two multiparous females ( 6 percent of the patients ) complained of minor transient anal incontinence ( score , 3 ) . Chronic anal fissure recurred in one case ( 3 percent ) after treatment . At manometry , the preoperative anal resting pressure decreased from 91 ± 11.2 to 70.5 ± 5.6 and to 78 ± 5.7 mmHg , 6 and 12 months after pneumatic balloon dilation , respectively ( P < 0.0001 ) . Anal ultrasonography did not show any significant sphincter defect . CONCLUSIONS Pneumatic balloon dilation seems to be an effective , safe , easy procedure that decreases anal resting pressure without endosonographically detectable significant sphincter damage
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 .