Closed Versus Open Lateral Internal Sphincterotomy in Treatment of Chronic Anal Fissure: A Comparative Study

Abstract

Hamid H. Sarhan

Abstract Background: An anal fissure is a common and painful disorder. The most common surgical treatment of a chronic anal fissure is lateral internal sphincterotomy with either open or closed methods, associated with a risk of pain, bleeding, recurrence and incontinence. Objectives: This study was designed to compare the results of an open and closed technique of lateral internal sphincterotomy in the treatment of chronic anal fissures. Patients and Methods: One hundred patients with a chronic anal fissure were admitted to the surgical unit of Tikrit Teaching Hospital, during the period of Jan. 2011 to Jan. 2012, treated by open or closed lateral internal sphincterotomy. The patients were followed up for a period of 12 months after surgery. The results of treatment were evaluated with reference to postoperative complications and outcomes. Results: Out of the 100 patients included in the study, 50 patients underwent open lateral internal sphincterotomy and the other 50 patients were subjected to closed lateral internal sphincterotomy. There was a significant difference in postoperative complications. However, incontinence was 20% in the open method and 8% in the closed method, the recurrence rate being 12% in open and 8% in closed methods; and the infection was 8% in open and 2% in the closed method. Conclusion: Closed lateral internal sphincterotomy is the treatment of choice for a chronic anal fissure with an acceptable complications rate. Key words: Anal fissure, lateral sphincterotomy, open, closed