Fissurectomy with posterior midline internal sphincterotomy and anoplasty in the management of chronic posterior anal fissures

Abstract

ObjectiveThe objective of this study was to evaluate the efficacy and safety of fissurectomy with posterior midline internal sphincterotomy and mucosal anoplasty in the management of chronic posterior anal fissures in terms of symptomatic relief and complications. Methods160 patients (male 74, female 86) aged 23–75 years (mean age, 38 years) were diagnosed having chronic anal fissures. Eighty patients from among them were randomly chosen for fissurectomy with posterior midline internal sphincterotomy and anoplasty (FPMISA), and the other 80 patients were chosen for lateral internal sphincterotomy (LIS). However, patients with acute anal fissures, fissures due to Crohn's disease, ulcerative colitis, tuberculosis, anterior fissures and hypotonic sphincter were excluded from this study. Symptomatic relief, postoperative healing and complications such as incontinence, keyhole deformity and recurrence were studied for a follow-up period of 18–24 months between September 2016 and December 2018. ResultsNone of the patients had bleeding per anum, except minor postoperative pain. In the FPMISA group, wound healed in 74 patients (92.5%) in 2–4weeks. However, 6 patients (7.5%) developed a keyhole deformity with a serosanguinous discharge duo to bacterial infection, which ultimately healed taking further 2 weeks. Transient incontinence to flatus (6.25%) and faeces (3.75%) were seen. None of the treated patients reported recurrence. On the other hand, in the LIS group of patients, wound healed in 90%, taking about 4–6 weeks. There was no significant difference in incontinence. ConclusionFissurectomy with posterior midline internal sphincterotomy and mucosal anoplasty is safe with minimal complications. It is still a dependable alternative treatment for chronic posterior anal fissures. The fear of keyhole deformity can be well addressed with the added anoplasty.