Conservative and Surgical Treatment of Chronic Anal Fissure: Prospective Longer Term Results

Abstract

In conclusion, although LIS is far more effective than medical treatments, BTX injection/fissurectomy as first line treatment may significantly increase the healing rate while avoiding any risk of incontinence.

The effect of lateral internal sphincterotomy on resting anal sphincter pressures*

“…Despite the limited data in the literature, surgical sphincterotomy is shown to reduce the anal sphincter tone effectively (22,23). Decreased anal sphincter tone results in the healing of anal fissures and low recurrence rates (24). Incontinence remains the main distressing complication after the operation.…”

Medical and surgical treatment of haemorrhoids and anal fissure in Crohn’s disease: a critical appraisal

“…However more than half of the patients developed some complications after surgery, mainly difficulties in wound healing, confirming the higher risk compared to the general population. Indeed in literature complication rates range from 7% to 42%, and in our experience in unaffected subjects, it is about 10% [28,29]. …”

Advancement flap in the management of chronic anal fissure: a prospective study

“…This technique is associated with fewer complications than posterior sphincterotomy, with immediate improvement of pain and success rate above 95 % [2]. However, it is associated with significant incidence of postoperative incontinence ranging between 0 and 35 % for flatus, 0 and 21 % for liquid, and 0 and 5 % for solid stools [4] with an overall incontinence risk as high as 10 % [3]. Variations could be due to operative technique, length of follow-up or criteria used to define anal incontinence [16].…”

“…They combined local isosorbide dinitrate with fissurectomy in 15 patients and described healing rates of 100 % within a follow-up of 29 months [22]. Few recent studies [4,[23][24][25][26][27][28] To cover the exposed area after fissurectomy, an advancement skin graft has been mostly used. Only recently, a mucosal advancement flap has been used [29,30].…”

“…Nonetheless, this does not take into account the normal weakening of the sphincter with age and the possibility of future anorectal surgery, radiation or obstetrical trauma. Therefore, the risk of incontinence after lateral internal sphincterotomy should be taken into account looking at the life span of the patient [4].…”