Internal Sphincterotomy Research Articles

Comparative study of manual anal dilatation and lateral internal anal sphincterotomy in the treatment of acute anal fissure

Background: An anal fissure is an extremely common condition which is also one of the most painful condition. It can be very troubling because, if acute, the severity of patient discomfort and extent of disability far exceed that which would be expected from a seemingly trivial lesion. This study compares two most commonly done procedures for anal fissure, manual anal dilatation (MAD) and lateral internal anal sphincterotomy (LAS).Methods: This is a prospective cohort study comparing MAD and LAS in the treatment of chronic anal fissure at Sri Venkateswara Medical College, Tirupati, from December 2017 to December 2018. A total of 60 patients who met inclusion criteria were randomized to undergo either MAD or LAS and analyzed for post-operative pain, post-operative complications, hospital stay, recurrence rates and compliance.Results: Total 60 patients were randomized to MAD and LAS. The patients who have undergone LAS have better pain relief and slightly increased risk of infection. Those who have undergone MAD have less risk of infection and recurrence rates and complications are not significantly less than LAS.Conclusions:MAD and LAS are both equally effective and safe for treatment of acute anal fissure with less chances of recurrence. However postoperative pain was slightly more in MAD group.

Outcome of bilateral versus unilateral lateral internal sphincterotomy for chronic anal fissures

Background: Gold standard treatment for chronic anal fissure is lateral internal sphincterotomy (LIS) which is usually performed at a single location. This randomized study compares bilateral to unilateral lateral internal sphincterotomy.Methods: Patients were randomized into two equal groups (64 each) to undergo either bilateral (Group A) or unilateral (Group B) open lateral internal sphincterotomy (LIS). Comparative study was done in terms of symptomatic relief of pain, incontinence, complete healing of fissure, and recurrence. Chi-square test was used as a test of significance.Results: Both groups had comparable demographic and clinical characteristics. Mean operative time for was longer for bilateral LIS (P-value <0.05). Mean pain score (VAS) in bilateral LIS group was lower in early post-operative period (P-value <0.05). At the end of 4th week 65.6% of patients in bilateral LIS group and 56.25% of patients in unilateral LIS group had completely healed fissures (P-value <0.05). Mean Wexner score for incontinence was comparable, while significant decrease in resting anal pressure was noted at 1 month in BLIS group. There was one recurrence in unilateral LIS group.Conclusions: Bilateral LIS resulted in better outcome in terms of early pain relief, early reduction of anal pressures, complete healing rate in 4 weeks with no recurrence. It does not increase the risk of incontinence and has better patients’ satisfaction as compared to unilateral LIS.

Postero-lateral Internal Sphincterotomy vs Botulinum Toxin Injection in the Treatment of Chronic Anal Fissure: A Randomized Controlled Trial

Postero-lateral Internal Sphincterotomy vs Botulinum Toxin Injection in the Treatment of Chronic Anal Fissure: A Randomized Controlled Trial

Comparison between lateral sphincterometry and Lord’s operation in treatment of anal fissure

Background: Two widely performed surgeries include Lord’s anal dilatation (LAD) and lateral internal sphincterotomy (LIS). LAD is one of the ancient and simple surgical techniques, but with high incidence of recurrence and incontinences. LIS is the preferred surgical technique these days, but again with high incidence of incontinence. Aim of this study was done to compare LAD with LIS in the treatment of anal fissure with regard to symptoms, post-operative complications and recurrence.Methods: In the present study the age of patient was to be between 18–50 years, having CAF, all the patients having CAF not responded to the medical management for more than 6 weeks. The patients were randomly assigned to either group. Pre and post-operative pain was accessed using Wong-baker faces pain rating scale. Constipation was accessed by modified Longo score. Incontinence was accessed by scoring system reported by Wexner.Results: When the Wong Bakers faces pain score was done there were 69% of patients with grade IV score and 31% had grade V pain score. The second most presenting complaint was of bleeding per rectum, it was found in 80% of the patients. For constipation the preoperative modified Longo score was 14. On examination sentinel tag was present in all the cases out of which 93% was posterior, 5% anterior and multiple in 2% cases.Conclusions: A total of 200 patients were studied during the study. In this study, females were commonly affected than males. Constipation was the major predisposing factor among all cases 85%. Most of the fissures were located in the posterior midline 89%. Anterior fissures were slightly more common in females. It is our view that the role of pharmacological agents is likely to assume greater prominence in the future and that more effective agents and modes of delivery will be developed.

Closed Lateral Internal Anal Sphincterotomy Under Local Anesthesia for Treatment Of Chronic Anal Fissure: Our 10 Years Experience

Background: Chronic anal fissure is one of the most frequent proctological disorders worldwide. Closed Lateral Internal Sphincterotomy (LIS) is one of the therapeutic options accepted as the treatment of choice for Chronic Anal Fissure (CAF) as it reduces the hypertonia of the internal anal sphincter, decreases anal pain, and allows the fissure to heal. LIS can be done under general anesthesia or local anesthesia. Aim of this study was to see the post operative outcome of closed LIS done under local anaesthesia. Materials and methods : This retrospective study was conducted in Department of Surgery of Chattogram Medical College hospital and some private hospitals of Chattogram city from January 2008 to December 2017. Total 550 patients of CAF who underwent closed LIS under local anesthesia were included. Atypical fissures associated with other disease were excluded. Results: The mean duration of hospital stay was 3.38 ± 1.2 hours. Sentinel skin tag was excised in 296 patients. The fissure was posterior in 73.63% patients and anterior in 7.81% patients. Recurrence was noted in 1.3% patients within four months. 63.27% patients experienced normal continence except occasional lack of fecal control postoperatively and only one patient developed gross incontinence of solid and liquid stool. Conclusion : This study concluded that closed LIS under local anaesthesia is the procedure of choice for management of CAF as it is cost effective and time saving.
 JCMCTA 2018 ; 29 (2) : 53-56

Comparison of Open Versus Closed Lateral Internal Sphincterotomy in the Management of Chronic Anal Fissure

An anal fissure is a longitudinal split in the anoderm of the distal anal canal, extending from the anal verge proximally towards, but not beyond, the dentate line. Various surgical methods of treatment of chronic anal fissure (CAF) are available, including anal dilatation, fissure excision, fissure excision with sphincterotomy, open lateral anal internal sphincterotomy and closed lateral anal internal sphincterotomy. This prospective study compared the results and complications of the open and closed techniques of lateral internal anal sphincterotomy in patients with CAF. A total of 60 patients with CAF were enrolled in this study, of which 30 underwent open lateral sphincterotomy and 30 underwent closed lateral sphincterotomy. Post-operative complications (pain, bleeding, constipation, perianal abscess, incontinence) were compared between the two groups. Postoperative pain, bleeding, and constipation were significantly less in the group undergoing closed surgery (p > 0.05). Perianal abscess and incontinence did not occur in any study subject. Closed lateral anal sphincterotomy is the treatment of choice for CAF. It can be performed effectively and safely, with a low rate of complications and a reduced cost burden.

Evaluation of the results of patients who had undergone lateral internal sphincterotomy due to chronic anal fissure: analysis of 281 cases

Evaluation of the results of patients who had undergone lateral internal sphincterotomy due to chronic anal fissure: analysis of 281 cases

Evaluation of the results of patients who had undergone lateral internal sphincterotomy due to chronic anal fissure: analysis of 281 cases

Introduction and purpose: Pharmacological and surgical treatment options are available for the treatment of chronic anal fissure (CAF). Pharmacological treatments include treatment modalities such as glyceryl trinitrate, calcium channel blockers and alpha-adrenoreceptor antagonists. Surgical treatment options include anal dilatation and sphincterotomy, and among many sphincterotomy procedures open lateral internal sphincterotomy (open LIS) is now considered the gold standard. The aim of this study was to investigate the demographic data, complaints, early and late complications of patients who have undergone LIS due to chronic anal fissure and to contribute to the literature. Material and method: Data of 281 patients who have undergone open LIS operation between 2013-2018 due to chronic anal fissure that did not respond to conservative treatment were analyzed retrospectively. Age, gender, complaint (pain, bleeding, constipation, itching), follow-up period and postoperative complication (infection, bleeding, pain, fistula, gas or stool incontinence) data of the patients were evaluated retrospectively. Patients with gas or fecal incontinence were evaluated with Wexner incontinence score. Results: Out of 281 patients, 197 were female (70.1%), 84 were male (29.9%). Female / male ratio was 2.34. The mean age was 40.31 ± 13.59 (min 18-max 84) years. The mean follow-up period was 24.53 (min 6 - max 67) months. In 248 (88.3%) patients, pain was noted during defecation, while bleeding was noted in 208 (74%) patients, constipation was noted in 133 (47.3) patients and perianal itching was noted in 91 (32.4%) patients. In 7 (2.5%) patients, infection occurred at the site of operation. Perianal fistula was seen in one patient (0.4%), recurrence was seen in 12 (4.3%), transient gas incontinence was seen in 4 (1.8%) and fecal incontinence was seen (0.35%) in 1 patient. Seven patients who had developed infection responded to oral antibiotic treatment and none of them developed abscesses. Result: As a result, open LIS operation is an efficient and effective surgical treatment method for the treatment of CAF.

A comparative study of open (Milligan-Morgan) versus closed (Ferguson) haemorrhoidectomy with and without internal sphincterotomy

Background: Normal anal canal contains cushion of submucosa with vascular tissues. When cushions become abnormal , cause symptoms. This clinical condition is known as haemorrhoids. Haemorrhoidectomy is surgery for haemorrhoids, which can be performed by Milligan-Morgan (open technique) or Ferguson (close technique) methods. This study is conducted to compare different surgical modalities of treatment for haemorrhoids.Methods: In total, 232 patients suffering from haemorrhoids with or without fissures were included in the study. Patients were categorized into two groups. Patients undergoing open technique were designated as open group, similarly patients undergoing close technique were designated as close group. In both groups for few patients internal sphincterotomy (I.S.) was performed. Post-operative pain was assessed by visual analogue scale in all groups, per operative haemorrhage was assessed by number of swabs used during surgery and VAS estimation, operating time and post-operative hospital stay were recorded.Results: 136 patients were suffering from haemorrhoids with fissures. Of these 84 patients were operated by open technique and 52 patients by close technique. In all 136 patients, internal sphincterotomy was performed. Remaining 96 patients were suffering from only haemorrhoids. Of these 30 patients were treated by open technique with I.S., 30 patients were treated by close technique only. 25 patients were treated by close technique with I.S. and 10 patients were treated by close technique without I.S. Close group and open group with I.S. experienced less pain compared to without I.S. in both groups. Per operative haemorrhage and hospital stay in close group was less . Operative time in open group was less compared to close group.Conclusions: Ferguson procedure is found to cause less post-operative discomfort. Addition of internal sphincterotomy is having a positive effect in reducing post-operative pain.

Combined mucosal advancement and lateral internal sphincterotomy in treatment of chronic anal fissure: could be an effective alternative procedure?

Background: Chronic Anal Fissure (CAF) is a common anal problem. Lateral Internal Sphincterotomy (LIS) is the recommended treatment when conservative treatment fails, however it has its drawbacks. On the other hand, Anal Advancement Flap (AAF) may help in some cases. In this study, we tried to combine both techniques to evaluate the outcome of this dual procedure.Methods: This prospective study was conducted on one hundred patients with chronic anal fissure who were divided randomly into two groups group (A) LIS, group (B) the combined technique. Both groups were compared regarding, pain and constipation prior to treatment and at 1, 2, 4, 6 weeks post-operative using Visual Analogue Scale (VAS) and Wexner constipation score at 6weeks in addition to timing of complete fissure healing.Results: Both groups were comparable preoperatively regarding demographic data, pain score, constipation score but post-operative group B has achieved an earlier significant decrease in pain score, (1.7±0.65 vs 4.4±1.1) at 1st week (P<0.001) and (1.5±0.55 vs 3.3±1.04) at 2nd week also (P<0.001). In addition to a superior healing rate (96% vs 76%) at 4th week (P=0.009) with non-significantly longer operative time or complication rate.Conclusions: The combined technique of mucosal advancement and LIS can achieve a superior outcome compared to the traditional LIS in the treatment of CAF regarding faster healing rates with marked decrease in early post- operative pain and by far earlier return to normal life habits.

Comparison of Partial Internal Sphincterotomy and Partial Internal Sphincterotomy with Additional Advancement Flap Anoplasty in the Treatment of Chronic Anal Fissure

Introduction: We aimed to compare the results of our patients who have undergone lateral internal sphincterotomy and lateral internal sphincterotomy with additional advancement flap anoplasty. The success rate and complication rate of both methods were compared concerning the literature. Materials and methods: We have retrospectively evaluated charts of patients who have undergone the operation for chronic anal fissure between January 2015 and July 2018. A total of 123 patients were separated into two groups as partial Lis+anoplasty (group-I, n:76) and only partial Lis (group-II, n:47) groups. Age, sex, follow up time, anal examination findings, pain, bleeding, constipation score, patient satisfaction score, VAS pain score during rest or stooling, and recurrence and continence rates of patients were recorded. Results: 61 male (49,59%) and 62 female (50,41%) total 123 patients were included. The mean age of the patients was 42,87±11,69 years. The duration of the operation was 28,50±11,61 min. The hospital stay was 1,50±0,70 days. The mean follow-up time was 24±10 months. In group-II patients (15.22%), the recurrence was higher than group I. Similarly, bleeding (10.87%), pain (13.04%), and discomfort (15.22%) were higher in group-II compared to group-I. Bleeding, constipation score, VAS stooling and resting scores were higher in group-II, while the satisfaction score was found higher in group-I. There was no difference between the two groups in terms of incontinence rate. Conclusion: Adding advancement flap anoplasty to partial internal sphincterotomy has increased the success rate by decreasing recurrences in our study and similar studies in the literature.

Apamarga Ksharasutra application and open lateral internal sphincterotomy in the management of Parikartika (chronic fissure‑in‑ano): A randomized controlled clinical trial.

Introduction:Parikartika resembles fissure‑in‑ano which is one of the common painful disease among the anorectal disorders. Ksharasutra which is a para‑surgical procedure is effective in the management of Parikartika.Aim:To compare the efficacy of Apamarga Ksharasutra and open lateral internal sphincterotomy (OLIS) in the management of Parikartika (chronic fissure‑in‑ano).Materials and Methods:Total 30 patients having signs and symptoms of Parikartika (chronic fissure‑in‑ano) were selected and randomly divided into two groups. In Group A (n = 15), Ksharasutra ligation after anal stretching was carried out while in Group B (n = 15), OLIS with excision of skin tag was carried out under local anesthesia or spinal anesthesia. Relief in postoperative symptoms and complications if any was recorded for 4 weeks and follow‑up was done for the period of 1 month.Results:In both the groups, significant results were obtained, but the difference among groups was statistically insignificant. Duration required for relief in postoperative pain, bleeding, swelling, and wound healing was found to be more in Group A (Ksharasutra) than Group B (OLIS).Conclusion:OLIS provided better results compared to Ksharasutra ligation in the management of Parikartika (chronic fissure‑in‑ano).

Comparative Study of Chemical Sphincterotomy and Lateral Internal Sphincterotomy for Chronic Anal Fissure

Introduction Fissure-in-ano is a very common problem which causes considerable morbidity and affects the patient's quality of life to a great extent. This warrants prompt treatment of the condition with appropriate methods. In this study, we assess and compare the efficacy and adverse effects of topical application of 2% Diltiazem gel with that of Lateral internal sphincterotomy. Method 100 patients with chronic fissure in ano were divided into Diltiazem gel and Lateral internal sphincterotomy groups and followed up at regular intervals for symptomatic relief and healing. Results Fissure was completely healed in 42 (89.36%) out of 47 patients by 8 weeks in the Diltiazem group, 3 patients experienced mild headache, 2 local irritation, 13 patients were pain-free at the end of 4 weeks, 26 patients were 8 weeks and 3 patients by 14 weeks. 5 patients were not relieved of pain at the end of 14 weeks. Completely healed in 48 (100%) out of 48 patients by 4 weeks in the Lateral Internal Sphincterotomy group.21 patients experienced post-operative pain and incontinence for flatus in 1 patient. 32 patients were pain-free by 4 weeks and all the patients were free of pain by 8 weeks. Conclusion The current study shows results in favour of lateral internal sphincterotomy with a healing rate of 100% with a faster pain-relief and minimal complications if performed by the experienced surgeon. However topical 2% diltiazem gel is an effective agent can be safely prescribed for patients having contraindications for surgery. With a healing rate close to 90%, topical 2% Diltiazem therapy can be advised as the first line of treatment for the treatment of chronic anal fissure.

COMPARATIVE STUDY OF 2% DILTIAZEM OINTMENT VERSUS LATERAL INTERNAL SPHINCTEROTOMY IN THE TREATMENT OF CHRONIC ANAL FISSURE

Objective: Comparative study of 2% Diltiazem ointment versus lateral internal sphincterotomy in the treatment of chronic anal fissure. Study Design: The present study included a total of 50 patients presenting with chronic anal fissure. First 25 patients were subjected to 2% Diltiazem ointment(Group A) and the next 25 patients underwent open lateral internal sphincterotomy(Group B). Patients were followed twice a week initially and then at the end of 3rd and 6th week. At each visit they were examined for symptomatic relief of pain (VAS), healing of fissure, side effect or complications. The healed fissures were then subsequently followed up at 3 month for recurrence. Results: Complete relief of pain and fissure healing was observed in 72% and 96% patients in Group A and B respectively which is statistically significant for pain relief but not for fissure healing(p>0.001).There were no side effects such as pruritus ani in Group A or incontinence in Group B. Only 5.5% of patients in Group A and 8.33% in Group B had recurrence at the end of 3 month. However, there was no statistically significant difference in the frequency of recurrence between the two groups (P=0.561).Conclusion: Lateral Internal Sphincterotomy may be regarded as treatment of choice in the management of chronic anal fissure where as 2% Diltiazem can be used in elderly patients and those who refused surgery.

Comparative Study of Lateral Internal Sphincterotomy vs Glyceryl Trinitrate Ointment for Fissure in Ano

Aim To compare and find out the effectiveness of lateral internal sphincterotomy as well as glyceryl trinitrate in the treatment of anal fissure. Materials & Method A prospective study of 100 patients at the surgery department of a medical college and tertiary health care centre, over a period of 6 months that included cases of fissure in ano in the age group of 18 yrs and 70 years. They were randomly assigned to two different groups. One for surgery and the other for medical management with GTN. Each group had 50 patients in it. Results The pain relief of the patients after the surgical operation was fast and very satisfactory. On follow up at 2 weeks post operatively, pain and other symptoms were present in only 10patients (20%). Whereas the pain relief in medical management group was not fully satisfactory and it took more time.. and it was only temporary and how ever on follow up at 2 weeks, 15 patients came with recurrent pain and other symptoms.(30%). On follow up at 8 weeks, in both groups,all the 100 patients were symptoms free (100%) in this study. The complications that were observed during this study were soiling in 5 patients (10%) and incontinence to flatus in 2 patients (4%) in the surgical group and headache in 10 patients (20%) and peri anal itching in 4 patients (8%) in the medical management group.. how ever there was no recurrence of anal fissure observed in this study group. Conclusion From the above study, it is proved that lateral internal sphincterotomy is by far the best operation for pain relief and rapid cure for fissure in ano

Treatment of a chronic anal fissure with a botulin toxin A injection and fissurectomy.

pharmacological treatment of a chronic anal fissure (CAF) achieves healing in half of cases and lateral internal sphincterotomy (LIS) is the definite treatment. The objective of this study was to assess the combination of fissurectomy and botulin toxin A (BTA) injection. this was a retrospective study of 54 patients with anal sphincter hypertonia and CAF treated with an injection of BAT and fissurectomy, after an unsuccessful management with topical nitroglycerin (NGT) for eight weeks. Fissurectomy and an injection of BTA (33 or 50 units) in the internal anal sphincter was performed during the same session. The main outcome measure was the healing rate, with incontinence and the need of LIS as secondary outcomes. two patients were excluded from the study, one due to Crohn's disease and the other was lost to follow-up. Of the 52 patients included in the study, there were 36 females (70%) and 16 (30%) males, with a mean age of 49 years (range 22-75). Fissure healing was initially achieved in 49 patients (94.2%) and LIS was required in the remaining three patients (5.8%). After initial healing, 18 patients (34.7%) developed 23 recurrences at a mean time of 27 months (5-83 months). Of these patients, healing with conservative sphincter measures was obtained in eleven cases (NGT in eight and repeat fissurectomy and BAT in three); two patients are currently under treatment with NGT and five underwent LIS. BTA injection associated with fissurectomy is a safe and effective procedure in patients with CAF, avoiding the need of LIS in a high percentage of patients.

Botulinum Toxin Vs Lateral Internal Sphicterotomy for Anal Fissures

A prospective study of 60 patients with anal fissures that aims to compare between two different types of treatment (Botulinum toxin A injection BTA and lateral internal sphincterotomy LIS) regarding pain-relief, healing rates and side effects and to establish a systematic method to be followed in the treatment.

Role of Anorectal Manometry in Anal Fissure and Outcome of Tailored Lateral Sphincterotomy in Hypertensive Internal Anal Sphincter: A Modified Minimal Invasive Technique

AbstractBackground: CAF is a common benign anorectal problem that substantialy impairs the patient's life. Consequently, a rapid and effective solution is required.1Aim of Study: To do lateral internal sphincterotomy extending up to the upper end of the fissure (but not to the dentate line) in patients have CAF with hypertonic IAS to keep continence. In case of low RAP, V-Y plasty will be done.Patients and Methods: Our study was done on 34 patients with CAF divided into 2 groups, group 1 included 28 patients with hypertonic IAS underwent tailored LIS and group 2 included 6 patients with normotonic/ hypotonic IAS underwent V-Y plasty to keep continence from June 2017 till December 2017 in general surgery department ,Assiut university hospital.Results: In group 1 there is no incontinence or recurrence, complete healing of fissures occurred in 96.4%. Only one patient had unhealing fissures, postoperative complications include bruising occurred in 3.5% and minor sepsis of sphinc-terotomy wound in 3.5%, in group 2 there is minor sepsis of the flap in 16.6%.Conclusion: Our study was done on 34 patients with CAF. These patients were divided according to anomanometric study into 2 groups: - Group 1 included 28 patients with high RAP in whom tailored LIS was done by modified technique which is taiored equal to the length of the fissure which is minimally invasive with good healing rate and no recurrence or incontince postoperative and minor bruising and sepsis of the wound and significant reduction in postoperative RAP. - Group 2 included 6 patients with normotonic /hypotonic IAS in whom excison of fissures were done and the defect is closed by V-Y plasty with good healing rate and low postoperative sepsis.So tailored lateral internal sphincterotomy is the effective treatment of CAF with anal hypertonia, safe and not affect continence.

Efficacy of chemical sphincterotomy with 2% diltiazem cream vs. surgical sphincterotomy in the management of chronic fissure in ano: a clinical study

Background: Surgical intervention like lateral internal sphincterotomy is very effective and in a time of few weeks, healing can occur but there is danger of the anal incontinence. Hence alternative methods were sought like 2% diltiazem and other agents and they have been shown to lead to proper healing without anal incontinence. The objective was to study efficacy of chemical sphincterotomy with 2% diltiazem cream vs. surgical sphincterotomy in the management of chronic fissure in ano.Methods: A hospital based follow up study was carried out among 60 patients with chronic fissure in ano. They were randomly assigned in two groups. Group I consisted 30 patients who were treated with 2% diltiazem cream on outpatient basis. Group II patients i.e. 30 patients were operated for sphincterotomy. Both the group patients were followed for six weeks at two weeks interval. Outcome like complete healing, fecal incontinence, flatus incontinence was seen at follow up. Chi square test and t test were used to determine the significant difference between the groups.Results: Both the groups were comparable to each other in terms of age, sex, presenting symptoms, mean duration of symptoms and internal findings. Diltiazem group patients had significantly much better healing rate i.e. 96.7% compared to only 80% from patients with surgery group. Incidence of complications like fecal/flatus incontinence was zero in diltiazem group compared to 13.3%/20% in surgery group.Conclusions: Authors conclude that diltiazem 2% topical application is better than surgical sphincterotomy and should be used instead of surgery.

Outcome of Modified Park's Technique for Treatment of Complex Anal Fistula

BackgroundTreatment of complex anal fistula (CAF) can be associated with high rates of recurrence and fecal incontinence (FI). Park suggested drainage of the affected intersphincteric anal gland for treatment of cryptoglandular anal fistula; however, recurrence after this technique was high. We modified the original Park's technique by extending the internal sphincterotomy to ensure adequate drainage of the intersphincteric space. The aim of this study was to evaluate the incidence of recurrence and FI after modified Park's technique in treatment of CAF. MethodsAdult patients of both genders with CAF were evaluated before undergoing modified Park's technique with Wexner continence score, clinical examination, and endoanal ultrasonography or MRI. Postoperatively, patients were examined every 2 wk until complete wound healing. The continence state was evaluated with Wexner continence score, and quality of life was assessed before surgery and at 6 mo postoperatively by Short Form–36 questionnaire. ResultsThirty-two patients (27 male) of a mean age of 38 y were included. Median follow-up was 12 mo. Two patients (6.25%) experienced recurrence and 5 (15.6%) developed complications. One patient (3.1%) developed new-onset FI postoperatively. Twenty-eight (87.5%) patients were completely satisfied with the procedure. Quality of life showed significant improvement at 6 mo postoperatively. ConclusionsThe modified Park's technique is a promising procedure for the treatment of CAF with low recurrence and FI rates, and improved quality of life.