Treatment of chronic anal fissure using subcutaneous lateral internal sphincterotomy

  • Milan Miocinovic Department of Surgery, Clinical Hospital Dubrava, Zagreb, Croatia
Keywords: anal fissure, proctology, surgery, incontinence

Abstract

Retrospective analysis of 113 patients with chronic anal fissure treated surgically at the Department of Surgery, University Hospital Dubrava in a 10-year period from 1994 to 2003. Average patient age was 44 years, and there were 53% men and 47% women. The diagnosis was established using proctologic examination that included rectoscopy. Most common localization of the fissure was in the posterior anal commissure (90%) and much more seldom in the front commissure (10%). Average duration of symptoms was 14 months (6-20 months). Of 113 patients, 32 (28%) of them have been previously ineffectively treated with other methods in other centers (sclerosation and laser photocoagulation, anal dilataion, excision of the fissure). Patients were operated using the method of subcutaneous lateral internal sphincterotomy (SLIS). Control group comprised of 30 patients, conservatively treated with local application of 0.2% isosorbid-dinitrate ointment. At first control examination 95% of patients declared clearance of pain during defecation. At one month after surgery fissure healed in 107 (95%) patients. Among conservatively treated patients, fissure healed in 13% after one month and in 30% after 3 months (p<0.001). Four patients (3.5%) had recurrence. Treatment-related post-operative complications were seen in 3 (2.6%) patients, two perianal abscesses and one perianal fistula. Incontinence for flatus was observed in 10 (8.8%) patients and faecal soiling in 5 (4.4%) patients. Authors conclude that based on these results and those from the literature SLIS represents a very successful and safe method for treating chronic anal fissure.> <0.001). Four patients (3.5%) had recurrence. Treatment-related post-operative complications were seen in 3 (2.6%) patients, two perianal abscesses and one perianal fistula. Incontinence for flatus was observed in 10 (8.8%) patients and faecal soiling in 5 (4.4%) patients. Authors conclude that based on these results and those from the literature SLIS represents a very successful and safe method for treating chronic anal fissure.

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Published
2004-12-01
How to Cite
1.
Miocinovic M. Treatment of chronic anal fissure using subcutaneous lateral internal sphincterotomy. Acta Chir. Croat. [Internet]. 2004Dec.1 [cited 2021Dec.7];1(1):32-6. Available from: https://acc.hkd.com.hr/index.php/ACC/article/view/49
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