OPEN MIDLINE INTERNAL SPHINCTEROTOMY (WITH FISSURECTOMY) IN THE TREATMENT OF CHRONIC ANAL FISSURE

Abstract

Anal fissure represents one of the most common diseases of the ano-rectum in which there is denuded epithelium of the anal canal overlying internal sphincter. In this study 110 patients underwent posterior midline sphincterotomy as the treatment for their chronic anal fissures. Mean operating time was 5 minutes and no patient stayed at hospital overnight. All patients were followed-up for 6 months. Symptoms were relieved right following surgery. Four patients developed wound infection. Other 4 patients experienced some difficulty in micturition but none had retention. Six patients experienced relative incontinence to flatus for a couple of weeks postoperatively but all of them regained their sphincter control after that. No patient complained of incontinence for feces. There were no serious scarring of the area like keyhole deformities or its variants and none of the patients developed recurrence. Almost all the patients were satisfied with the outcome. We recommend posterior midline internal sphincterotomy as the surgical treatment of choice for chronic anal fissure because it is simple to perform and results in quick relief of pain and rapid healing in almost all cases, with very few complication and negligible recurrence.