A comparative study in anal fissure treatment.

275 patients with chronic anal fissure were treated by anal stretch, posterior internal sphincterotomy or lateral subcutaneous internal sphincterotomy. All operations were performed under general anesthesia. There was a six-month follow-up period where 23% of the patients who underwent anal stretch developed incontinence to flatus or faeces. Minor degrees of incontinence occurred in 8% of the posterior sphincterotomy group and 4% of the lateral subcutaneous sphincterotomy group. There was a 7% recurrence rate in the anal stretch group, 4% in the posterior sphincterotomy group, and 3% in the lateral sphincterotomy group. However, an excellent relief of symptoms was reported in all groups. The results of the study indicated that the anal stretch and posterior sphincterotomy procedures could be discarded; since the former procedure is associated with high incontinence rate, and the latter with a key-hole deformity, mucous discharge and pruritic symptoms.