Chronic anal fissure: a comparative study between surgical and chemical sphincterotomy

ABSTRACT

The standard treatment of chronic anal fissure is surgical in the form of lateral sphincterotomy. However, temporary incontinence for flatus or faeces occurs in up to 30% of patients. Recently, Glyceryl trinitrate has been used effectively to treat chronic anal fissure. This study compares the efficacy and complications of chemical and surgical sphincterotomy. This prospective randomized study included 30 patients with chronic anal fissure presenting to Kasr el Ainy hospital in the period from February to September 2002. The patients were divided randomly into two groups. Group A [15 patients] were treated surgically using the standard treatment of lateral sphincterotomy. Group B [15 patients] were treated using local nitrate donor "GTN". Patients using nitrates for coexisting pathology were not included in the study. Assessment of patients included detailed history and clinical examination. Anorectal manometry was performed before and after therapy to assess the efficacy of therapy. Follow up period ranged from 2-6 months. Results and complications In Group A [surgical sphincterotomy], fourteen patients had complete healing of the fissure in 8 weeks. One patient had complete healing in 12 weeks. Complications included discharge [6 patients, 40%], Bleeding [6 patients, 40%], temporary incontinence for 3 weeks [1 patient], incontinence for flatus [1 patient]. There was no recurrence of symptoms in any of the patients for the whole period of follow up. In group B [chemical sphincterotomy], eleven patients had complete healing of the fissure as evidenced by clinical and manometric study in 8 weeks [73%]. One patient had complete healing in 12 weeks; one patient stopped the treatment because of severe headache, while two patients did not respond to chemical therapy. Complications included headache which was severe in one patient to stop therapy, recurrence in two patients. There was no incontinence in any of the patients. The results of the present study suggest that surgical sphincterotomy was more effective in the treatment of chronic anal fissure [not statistically significant]. However, it was associated with more morbidity and complications. The study suggests to use Glyreryl trinitrate as a first line of treatment of chronic anal fissure because it is cheap, safe and associated with less complications especially incontinence