ABSTRACT
Chronic anal fissure is the most common cause of anal pain associated with internal anal sphincter hypertonia. Although lateral internal sphincterotomy [LIS] is an effective treatment of chronic fissure in ano, it has the potential to cause serious complications, the most distressing of which is incontinence to flatus and fecal soiling. We proposed fissurectomy [F] as an alternative surgical treatment. Experimental and Comparative Study. This study was conducted at Surgical Department, Ghulam Mohammad Mahar Medical College Sukkur. One hundred twenty four patients, divided into two groups. Sixty patients underwent fissurectomy and 64 underwent lateral internal sphincterotomy. After a median follow-up of 18 months, we compared the results of the two procedures. In addition to frequent visits on a predetermined basis, a telephone inquiry into fissure recurrence and continence status was made. All patients in either group were pain-free and without bleeding within one week. In both groups, urinary retention was noted in two patients. Incontinence to flatus occurred in four patients [6.2%] in the LIS group, but no incontinence was noted in the F group. There were two patients [3.1%] with fissure recurrence in the LIS group, but no one in F group. No patient in either group was afflicted with anal stenosis or perianal infections. All wounds healed within 6 to 8 weeks. 58 patients [96.6%] in the F group and 56 [87.5%] in the LIS group reported satisfactory results. In surgical treatment of chronic anal fissures not responding to conservative management, fissurectomy may be a sphincter-sparing alternative and perhaps a preferable surgical technique