Anal stretch plus fissurectomy for chronic anal fissure.

INTRODUCTION: Anal fissure is a common disease. Usually chronic anal fissures are managed medically. When conservative management fails, surgical treatment should be considered. Lateral internal sphincterotomy has been advocated as the first choice invasive treatment but it has a reported rate of major fecal incontinence of 5%. In order to reduce the onset of major fecal incontinence after anal fissure surgery, it has been proposed to use the anal stretching plus fissurectomy.

METHODS: From 2008 to 2011, 457 patients have been operated for chronic anal fissure.

RESULTS: Twenty-seven patients underwent lateral internal sphincterotomy, two patients underwent posterior sphincterotomy and 428 patients underwent anal stretch plus fissurectomy. Satisfactory results have been reported in 95% of the cases. Transient incontinence rates have been of 3% after anal stretch and of 14.8% after lateral internal sphincterotomy (p < 0.05). Major and persistent incontinence rates have been reported in a case after later internal sphincterotomy (3%) but never after anal stretching (p = 0.059). Recurrence occurred in 2% of the patients after anal stretch and in 3% of the cases after lateral internal sphincterotomy (p = ns).

CONCLUSION: Lateral internal sphincterotomy and anal stretch have nearly a reported 95% of good results but the first have 3-5% rates of major incontinence.