Initial Outcome of Lateral Internal Sphincterotomy with or without Fissurectomy in the Surgical Management of Chronic Anal Fissure

Abstract

Chronic anal fissure is a common proctological condition characterized by severe pain and bleeding during defecation. Surgical intervention is often required for chronic cases unresponsive to conservative treatment. This study aims to compare the outcome of lateral internal sphincterotomy (LIS) with and without fissurectomy. In this single-centered study, 50 purposively selected patients with chronic anal fissures were divided into two groups: Group A underwent LIS with fissurectomy, while Group B underwent only LIS. The primary outcomes measured were postoperative anal pain relief and fissure healing rates, while secondary outcomes included hospital stay duration and the occurrence of complications such as anal discharge, pruritus, bleeding spot, urine & stool incontinence. Group A showed a significant reduction in postoperative pain within 3 days (60% of patients) compared to Group B, which showed relief within 6-8 days (32% of patients). Fissure healing times were faster and hospital stay duration were shorter in Group A, with a mean duration of 5.12±1.616 days versus 8.32±3.18 days in Group B. The incidence of postoperative complications was lower in Group A, with anal discharge occurring in 16% of patients compared to 44% in Group B. These above differences were statistically significant. The study demonstrates that LIS with fissurectomy may offer better outcomes in the treatment of chronic anal fissures than LIS alone, including faster pain relief, improved healing rates and fewer postoperative complications. Given the limitations of a small sample size and single-center design, larger multi-center trials are recommended to confirm these findings and potentially adjust clinical practice guidelines.