مقايسه نتايج فيشركتومي با اسفنكتروتومي داخلي جانبي در درمان فيشر آنال مزمن با روش جراحي

A comparison between the results of fissurectomy and lateral internal sphincterotomy in the management of chronic anal fissure

Background: Although lateral internal sphincterotomy is an effective treatment of chronic fissure in ano, it may lead to serious complications, of these, incontinence to flatus and fecal soiling are the most distressing. To avoid such complications, we proposed fissurectomy as an alternative surgical treatment. Materials and methods: Totally, 62 consecutive patients through the sequential sampling were divided into two groups. 30 patients underwent fissurectomy (F) and 32 underwent lateral internal sphincterotomy (LIS). After a median follow-up of 22 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. Results: All patients in either group were pain free and without bleeding within one week. In both groups urinary retention was noted in one patient. Incontinence to flatus was in the LIS group in two (6.2%) patients but no incontinence was noted in the F group. There was one patient (3.1%) with fissure recurrence in the LIS group but no one in the F group. No patient in either group afflicted with anal stenosis or perianal infections. All wounds healed within 8 weeks. 29 patients (96.6%) in the F group and 28(87.5%) in the LIS group reported satisfactory results with their procedure. Conclusion: In the surgical treatment of chronic anal fissure not responding to conservative management, fissurectomy may be a sphincter-sparing alternative and perhaps preferable surgical technique with less total complications.