Open lateral sphincterotomy - A method of choice in the treatment of chronic anal fissure. Indications and results

Aim: The key to the treatment of chronic anal fissures is the reduction of the abnormal values of anal resting pressure. The aim of the surgical treatment is to reduce the activity of the internal anal sphincter and to provide proper conditions for the fissure to cure, which can be achieved by internal sphincterotomy. In the modern surgical practice the internal sphincterotomy is performed away from the fissure, lateral of the last, using open or closed technique.Methods: In our study we performed open lateral internal sphincterotomy (OLST) of 82 patients with chronic anal fissure, compared to a control group of 231 patients, treated with different methods. Results: We didn`t register any recurrences in the sixth post-operative moth after OLST. 11% of patients with OLST were with registered incontinence after the sixth post-operative month compared with 4.4% in non-OLST patients. The data was statistically significant (p=0.032)Conclusion: Choosing an OLST as a method for treatment of chronic anal fissure requires careful selection of patients. It is not recommended for patients with a risk of incontinence like those with a previous birth trauma, age beyond 60 years, previous ano-rectal operations, neurological diseases and low values in anal resting pressure.Aim: The key to the treatment of chronic anal fissures is the reduction of the abnormal values of anal resting pressure. The aim of the surgical treatment is to reduce the activity of the internal anal sphincter and to provide proper conditions for the fissure to cure, which can be achieved by internal sphincterotomy. In the modern surgical practice the internal sphincterotomy is performed away from the fissure, lateral of the last, using open or closed technique.Methods: In our study we performed open lateral internal sphincterotomy (OLST) of 82 patients with chronic anal fissure, compared to a control group of 231 patients, treated with different methods. Results: We didn`t register any recurrences in the sixth post-operative moth after OLST. 11% of patients with OLST were with registered incontinence after the sixth post-operative month compared with 4.4% in non-OLST patients. The data was statistically significant (p=0.032)Conclusion: Choosing an OLST as a method for treatment of chronic anal fissure requires careful selection of patients. It is not recommended for patients with a risk of incontinence like those with a previous birth trauma, age beyond 60 years, previous ano-rectal operations, neurological diseases and low values in anal resting pressure