Comparison between Open Lateral Sphincterotomy and Posterior Midline Sphincterotomy with Fissurectomy in Treatment of Chronic Anal Fissure

Author(s):

Deari A. Ismaeil*, Kamil Haydar, Ary Hama Saeed and Alaa Sabeeh

Background: Anal fissure is a common condition. Lateral internal sphincterotomy is recommended as the standard procedure for treating chronic anal fissure. Fissure healing can also be achieved by a posterior midline sphincterotomy, which may be associated with prolonged healing, as well as passive anal leakage.

Objectives: This is to compare the effectiveness and outcome between two methods of treating chronic anal fissure; open lateral internal sphincterotomy with fissurectomy versus posterior midline sphincterotomy with fissurectomy, in terms of post-operative complications; pain, infection, bleeding, bruising, abscess, fistula and incontinence.

Patients and methods: A Retrospective study including 100 patients presented with chronic anal fissure. The patients were distributed between two equal groups: group-A underwent open lateral sphincterotomy, and group-B underwent posterior midline sphincterotomy. Both groups were evaluated for postoperative complications. The patients were followed after the surgery at least for 9 months, up to 41 months, with mean of (27.69±7.31) months.

Results: From these 100 patients, 83 were females and 17 were males. The mean age was (33.17±7.06) years. The main symptom was pain, then bleeding and constipation. Most of the fissures were located at 6 o’clock. Postoperative complications found in 27 patients: infections found more in group-B, while bleeding, bruising and incontinence were more in group-A. There was no postoperative abscess or fistula formation, and no recurrence detected.

Conclusion: We found no differences in surgical treatment for the chronic anal fissure, between open lateral sphincterotomy and posterior midline sphincterotomy in term of symptomatic pain relief, healing rates and the side effect occurrence after operations.