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Chirurgia 2004 April;17(2):43-6


language: Italian

Operative procedures for anal fissure: open lateral internal sphincterotomy versus posterior midline sphincterotomy with anoplasty

Barisone P., Ippoliti M., Dezzani C., Abbo L., Aimo I.


Aim. The surgical treatment for anal fissure consists in the resolution of sphincterial spasm. Lateral sphincterotomy might be considered the standard technique although a satisfactory comparison between different techniques has not yet been made. The purpose of this paper is a comparison between open lateral sphincterotomy (LS) and posterior midline sphincterotomy with anoplasty, according to Arnous (PS). The following parameters have been considered: times of recovery, morbidity of procedures, recurrence rates and persistence.
Methods. One hundred and twenty operations for anal fissure have been performed from January 1995 to September 2002; 71 PS and 49 LS were performed. In 7 cases PS and in 4 cases LS were associated to other operations. Each patient was contacted by phone 6 and 12 months after operation and asked about symptoms, by means of a questionnaire, in order to evaluate their compliance with a numeric VAS.
Results. In the postoperative phase, there was 1 infection of the mucous part and 1 hemmorhoidal thrombosis in PS (2.8%), 2 hematomas and 1 abscess in proximity of the incision after LS (6.1%). There was 1 case of persistence in PS cases (1.4%); the mean recovery time was 10.4 weeks (range 6-24). In LS there were 2 cases of persistence of fissure (3.1%). Recovery mean time was 4.2 weeks (range 2-10). Twelve patients (10%) drop out from the study; 63 PS and 42 LS have been controlled: there was no recurrence in PS cases, but 2 cases (4.7%) in LS. There were 5 cases of incontinence for liquids feces and gas emission or soiling after PS (7.9%). Incontinence was not found after LS. In 15 cases (14.1%) VAS was unsatisfactory.
Conclusion. The conclusion is drawn that PS is an operation capable of recovering anal fissures, but with longer recovery times, longer anal pain, relatively high onset of incontinence: these factors may limit the indication for these procedures. Howrever, it's important to remember that anal fissure might be manifestation of more complex colorectal pathology.

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