Treatment of anal fissure: a comparison of three different forms of therapy.

454 patients with a fissure-in-ano were treated by different forms of therapy. In a follow-up we examined 314 patients, 178 of them having been treated by anal stretch, 60 of them by subcutaneous lateral sphincterotomy and 76 of them by conservative measures. Most of the anal stretched patients were free of symptoms. Only few of them had to be treated again for the same disease by their physician. Anal stretch--similar to sphincterotomy--breaks the pathologically raised sphincter tone. We therefore propose anal stretch gently performed over a period of 3-5 minutes under general anaesthesia as the method of choice for the initial treatment of anal fissure. In cases of relapse we recommend lateral sphincterotomy by an experienced operator.