Closed versus open lateral internal sphincterotomy in treatment of chronic anal fissure : a comparative study of postoperative complications and outcome

Abstract EN

Anal fissure is a common and painful disorder Its relation to hypertonic anal sphincter is controversial The most common surgical treatment of chronic anal fissure is lateral internal sphincterotomy either open or closed methods associated with a risk of pain, bleeding, recurrence and incontinence The study was designed to compare the results of open and closed technique of lateral internal sphincterotomy and to find postoperative complications.

This prospective clinical trial conducted in the Department of surgery in Basrah General Hospital between January 2006 and October 2008 one-hundred patients were randomly assigned to open or closed internal sphincterotomy Standardized questionnaires assessing patients were administered preoperative^ and at 1 st.

2nd weeks and 1-6 month postoperatively Out of the 100 patients included in the study.

50 patients underwent open lateral internal sphincterotomy and the other 50 were subjected to closed lateral internal sphincterotomy.

There was no significant difference in postoperative acute complications.

However, incontinence in terms of soiling and passage of flatus was 14% in open method and 10% in closed method there was no difference in terms of recurrence rate being 4% both in open and closed methods.

In conclusion there was no significant difference between open and closed methods of lateral internal sphincterotomy in regard recurrence rate healing rate hospital stay and other complications but in view of these findings closed method of treatment is recommended if the surgeon is experienced.