Lateral internal sphincterotomy for chronic idiopathic anal fissure: an alternative approach.

BACKGROUND

An alternative approach to lateral internal sphincterotomy in the management of chronic anal fissure is presented and its potential advantages are described.

METHODS

Using the conventional diathermy, the internal sphincter along with its overlying anoderm is cut to the caudal border of the dentate line.

RESULTS

This prospective study included 350 patients. Twenty-six patients (7.4%) reported spotting of blood with defecation and 266 patients (76%) reported minimal perianal discharge. The cessation of the discharge and spotting of blood correlated with the complete healing of the sphincterotomy wound. Urine retention requiring temporary catheterization was encountered in 19 patients (5.4%). Neither abscesses nor fistulae were encountered. Cure was achieved in all patients. Neither recurrences nor permanent fecal incontinence were encountered throughout the study period.

CONCLUSION

The alternative approach is efficient and safe and may be added to the surgeon's armamentarium when attempting lateral internal sphincterotomy for chronic anal fissure.