Treatment Of Chronic Anal Fissure Research Articles

A comparative study of the outcome of unilateral versus bilateral internal anal sphincterotomy in treatment of chronic anal fissure

Background: Gold standard treatment for chronic anal fissure is lateral internal sphincterotomy. Bilateral internal sphincterotomy (BIS) as a treatment option for chronic anal fissure has not been evaluated. Aims and Objectives: The aims and objectives of the study are to compare the efficacy of unilateral versus bilateral internal anal sphincterotomy in treatment of chronic anal fissure. Materials and Methods: Study design: A prospective randomized comparative study. Study area: Patients coming to General Surgery outpatient department at College of Medicine and Sagore Dutta Hospital with chronic anal fissure. Study period: July 2022 to December 2023 (18 months). Sample Size: 100 patients. Study Group: Group A=Patients who had undergone unilateral internal sphincterotomy (UIS)=50 patients and Group B=Patients who had undergone BIS=50 patients. Results: 2 (4%) patients in Group A and 3 (6%) patients in Group B developed incontinence for flatus postoperatively. No patients in either group developed incontinence for stools. The Mean Fissure Healing Time (Mean±SD) (Weeks) post-sphincterotomy was 4.32±0.91339 in Group A and 2.66±0.65807 in Group B. There were 6 cases of recurrence in the unilateral sphincterotomy group. Second surgery was needed in 4 patients who underwent unilateral sphincterotomy. Conclusion: As compared to UIS, BIS results in a faster healing of chronic anal fissure, with no increase in incontinence, decreased pain score, and less recurrence rates.

Comparison of outcome of botulinum toxin injection with and without glyceryl trinitrate in chronic anal fissure in terms of post operative pain and healing.

To compare the outcome of botulinum toxin injection with and without glyceryl trinitrate with respect to postoperative pain and healing in the treatment of anal fissures. The prospective, comparative study was conducted at the Department of General Surgery, Mayo Hospital, Lahore, Pakistan, from September 1, 2021, to August 31, 2022, and comprised adult chronic anal fissure patients of either gender. They were randomised using the lottery method into group A which received botulinum toxin injection, and group B which received botulinum toxin injection plus 1g of 0.2% topical glyceryl trinitrate cream. Post-operative pain was measured 24 hours after the procedure using the visual analogue scale. Healing was assessed by examining the wound for the appearance of granulation tissue 4 weeks post-procedure. Data was analysed using SPSS 26. Of the 88 patients, 44(50%) were in group A; 32(72.7%) males and 12(27.3%) females with mean age 33.91±14.8 years. There were 44(50%) patients in group B; 35(79.5%) males and 9(20.5%) females with mean age range 36.33±14.9 years. The mean postoperative pain at 24 hours in group A was 4.67±1.16 and it was 3.06±0.65 in group B (p=0.009). In group A, 23(69.7%) patients showed complete healing at 4 weeks compared to 30(90.9%) in group B (p=0.030). Botulinum toxin injection with glyceryl trinitrate could be considered as first line of treatment for chronic anal fissure in patients who refuse surgery and with previous sphincter surgery.

Efficacy of diltiazem 2% rectal gel in the treatment of chronic anal fissure: a retrospective observational study

Efficacy of diltiazem 2% rectal gel in the treatment of chronic anal fissure: a retrospective observational study

Can topical applicatıons be an alternative to surgery in the treatment of chronic anal fissures?

Can topical applicatıons be an alternative to surgery in the treatment of chronic anal fissures?

Comparative Analysis of Open and Closed Sphincterotomy for the Treatment of Chronic Anal Fissure: Safety and Efficacy Evaluation.

BACKGROUND Chronic anal fissure is a common condition that causes pain and discomfort and has a significant impact on quality of life. When conservative management fails, surgical sphincterotomy can be successful. This retrospective study from a single center in Turkey included 188 patients with chronic anal fissures and aimed to compare outcomes from open and closed sphincterotomy. MATERIAL AND METHODS This retrospective study included 188 patients treated with lateral internal sphincterotomy (LIS) for chronic anal fissure between January 2015 and December 2021 in our hospital. Open LIS procedure was performed in 91 patients and closed LIS was performed in 97 patients. Demographic characteristics, postoperative complications, and recurrence were compared for these 2 methods. RESULTS Of the 188 patients included in the study, 47.9% were women and 52.1% were men. The mean age was 42.9 (20-84) years. In the open LIS group, recurrence occurred in 2 patients (2.19%), and no incontinence was observed. In the closed LIS group, recurrence occurred in 3 patients (3%; P=0.703), and incontinence developed in 5 patients (5.15%; P=0.035). CONCLUSIONS Comparing the 2 methods used in chronic anal fissure surgery, and considering the recurrence and risk of incontinence, the most feared outcome by the patient and surgeon, open LIS stands out as a superior technique, especially in young male patients.

Botulinum toxin injection for chronic anal fissure: a prospective controlled study with long follow-up.

Botulinum toxin is an effective therapeutic option for chronic anal fissure. However, there is no evidence about treatment standardization and long-term follow-up. We aimed to evaluate the short- and long-term efficacy and safety of botulinum toxin compared to close lateral internal sphincterotomy, with a 5-year follow-up. This was a prospective, controlled, single-center study conducted at University Hospital of Ferrara, Ferrara, Italy. The primary outcome was fissure healing at 1 month. Secondary outcomes were Quality-of-Life (QoL) at 1 month and after 5 years, and fissure recurrence at 6 months and 5 years. A total of 59 patients received botulinum toxin injection (Botox), and 32 underwent lateral internal sphincterotomy. At 1 month after treatments, postoperative pain decreased faster and significantly more in the Botox group (30 vs. 60 mm; P<0.001); fissure re-epithelization was observed in 59.4% of the surgical group compared to 25.4% of Botox (P=0.0001). Anal sphincter pressures decreased more in surgical group (P=0.044), although severe anal incontinence was present only in this subset (6.2%; P=0.041). Compared to surgery, patients who received Botox had higher satisfaction rates (P<0.001). Fissure recurrence at 6 months was more common in Botox than surgical group (16.9% vs. 3.2%, respectively; P=0.053). The overall healing rate improved in all patients and persisted at 12 months and 5 years in both groups with overall high patient satisfaction despite mild anal incontinence in 21.8% in the surgery group (P<0.05). Botox, rather than surgery, should be considered the first-line treatment for chronic anal fissure.

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

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 &amp; 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.

Comparative Study of Lateral Internal Sphincterotomy versus Local 0.4% Glyceryl Trinitrate Ointment for the Treatment of Chronic Anal Fissure

Objectives: To compare the outcomes of “Lateral Internal Sphincterotomy (LIS)” versus local “0.4% Glyceryl Trinitrate (GTN)” ointment for the treatment of chronic anal fissure. Study Design and Setting: Randomized controlled trial, Combined Military Hospital (CMH) / Pak Emirates Military Hospital (PEMH), Rawalpindi from October 2022 to March 2023. Methodology: A total of 100 patients [50 in GTN group and 50 in LIS group] who underwent treatment for chronic anal fissure were included in study. Patients in both groups were followed up at eight weeks after the surgery to assess for the outcomes including anal pain healing and recurrence of fissure. Data was analyzed by SPSS 22.00. Results: In our study, mean age was 30.48 ± 5.82 years. 61 (61.00%) were male while 39 (39.00%) were female. Mean duration of having anal fissure was 10.69 ± 2.59 weeks. Mean post-therapy pain VAS at week 8 follow up in “GTN” group was 0.64 ± 1.06 while in “LIS” group it was 0.16 ± 0.37, (p = 0.003). Complete healing of chronic anal fissure was achieved in 35 (70.00%) in “GTN” group while in “LIS” group healing was achieved in 42 (84.00%), (p = 0.096). Recurrence occurred in 2 (4.00%) of patients in “GTN” group and none in “LIS” group, (p = 0.153). Conclusion: “Lateral Internal Sphincterotomy (LIS)” is a better treatment option for management of chronic anal fissure.

Outcomes of non-surgical treatment of chronic anal fissure: A comparative study

Background and objective: Chronic anal fissure is a common health problem related to high morbidity. The chemical option for treating chronic anal fissures is highly preferred. Methods: A clinical prospective comparative study was carried out in the General Surgery Outpatient Department in Rizgary Teaching Hospital, Erbil, KRG, during the period from January 2019 to December 2021,on a sample of 100 patients randomly recruited patients with chronic anal fissures divided into two groups with 50 participants each: the DTZ group, who received 2% diltiazem ointment, and the GTN group, who used 0.2% glyceryl trinitrate ointment twice daily for 6 consecutive weeks. The aim of the study is to compare the efficacy and effects of topical Diltiazem (DTZ) and topical glyceryl trinitrate (GTN) in the management of chronic anal fissures. Results: There was a highly significant association between fissure healing at the 4th week and patients treated with DTZ (P &lt;0.001). A highly significant association was observed at the 6th week between fissure healing and DTZ treatment (P &lt;0.001), while there was later a highly significant association between fissure healing at the 8th week and patients treated with GTN (P &lt;0.001). A significant association was observed between treatment adverse effects and patients treated with GTN (P = 0.05). DTZ was found to be more effective for symptomatic relief than GTN. Conclusion: Both DTZ and GTN are effective in the treatment of chronic anal fissures, but treatment with DTZ is accompanied by faster healing and lower side effects.

Comparison between open lateral sphinectomy and posterior midline sphinectomy with Fissecrectomy in treatment of chronic anal fissure

Objective: to compare the outcomes between two methods of treating chronic anal fissure; open lateral internal sphincterotomy (LIS) with fissurectomy versus posterior midline sphincterotomy (PIS) with fissurectomy, in terms of post-operative complications. Study design: Randomized control trial Place and duration: surgery department of Nishtar Hospital Multan from 10th February 2019 to 9th February 2020 in one year duration. Methodology: Patients presented at outpatient department of hospital and diagnosed as chronic anal fissure were enrolled in study and divided into two groups for treatment. Group A was treated with open lateral sphinectomy with fissurectomy and group B was treated with posterior midline sphinectomy with fissurectomy. SPSS version 23 was used for data analysis. Results:In LIS Group, the most common post-operative complication was infection 34.8%. The most common complication in PIS Group was also infection 77.8%. The differences were statistically significant for infection (p=0.000), bleeding (p=0.008) and bruising (p=0.000). Conclusion: No differences was observed between lateral internal sphinectomy and posterior midline spinectomy in term of healing rates, symptomatic pain relief and the side effect occurrence after surgeries.

Long-term Efficacy and Safety of Controlled Manual Anal Dilatation in the Treatment of Chronic Anal Fissures: A Single-center Observational Study.

Conventional anal dilatation for anal fissures has long been abandoned because of the high incidence of anal incontinence. However, less invasive and more precise dilation techniques have been developed that have shown high healing and low incontinence rates. This study aimed to evaluate the efficacy and safety of controlled anal dilatation (CAD) using a standardized maximum anal diameter. This study included 523 patients who underwent CAD for chronic anal fissures between January 2010 and December 2014. CAD was performed under sacral epidural anesthesia. The index fingers of both hands were placed in the anus and dilated evenly in various directions. CAD was completed when the anus was dilated to the sixth scale (35 mm in diameter) using a caliber ruler. The mean anal scale size expanded from 3.1 to 5.8 (p<0.001). Non-healing was observed in nine patients (1.7%) at 1 month postoperatively, six of whom underwent additional CAD. The mean maximal anal resting pressure (mmHg) decreased from 90.2 to 79.7 at three months postoperatively (p<0.001). Postoperative complications were observed in 11 (2.1%) patients, of whom three patients with thrombosed hemorrhoids underwent resection. None of the patients complained of anal incontinence during the mean follow-up period of 16.6 months. The cumulative recurrence-free rates at three and five years were 87.9% and 69.2%, respectively. CAD is technically simple and safe and can achieve reasonable long-term outcomes. Thus, CAD appears to be the preferred procedure for patients with chronic anal fissures who do not respond to conservative treatments.

Topical Sucralfate for Treatment of Chronic Anal Fissure.

Topical Sucralfate for Treatment of Chronic Anal Fissure.

Early outcomes of chronic anal fissure treatment using the lateral internal sphincterotomy method without excision (randomized trial NCT05117697)

PURPOSE OF THE STUDY: improvement of the treatment of chronic anal fissure results.PATIENTS AND METHODS: the study included 70 patients randomized by random number generation into 2 groups: 30 patients underwent lateral internal sphincterotomy (main group, LIS), and 40 patients underwent LIS in combination with the excision of the fissure (EF) (control group, LIS + EF).RESULTS: the pain intensity both after stool and during the daytime in the main group (LIS) has been significantly lower than in the control group (LIS + EF) (p &lt; 0.05). The median duration of the patients’ temporary disability in the LIS group was 6 (4; 9) days, in the LIS + EF group — 17 (9; 23.5) days (p = 0.04). On day 15, the defect has epithelialized in 12/30 (40%) patients of the main group (LIS) and none (0/40) in the control group (LIS + EF) (p = 0.00001), on day 30 — in 22/30 (73.3%) and 2/40 (5%) (p = 0.00001), on day 45 — in 26/30 (87%) and 20/40 (50%) (p = 0.002), and on day 60 — in 28/30 (93.3%) and 38/40 (95%) (p = 1.0), respectively. On the day 30 after surgery, 3/30 (10%) patients of the main group and 15/40 (37.5%) of the control group had complaints regarding passing gas (p = 0.01), on day 60 — anal sphincter insufficiency (ASI) persisted in 1/30 (3%) patients in the LIS group and in 3/40 (7.5%) patients in the LIS + EF group (p = 0.63). Excision of the fissure in 5.4 (1.4–20.9) times increases the chance of developing ASI on day 30 of the postoperative period (p = 0.015) and 52 (10.2; 268.3) times increases the chance of non-healing of the defect during this period (p = 0.000002) and 6.5 (1.9; 22) times on the day 45 (p = 0.003), in comparison with the LIS only.CONCLUSION: refusal to excise the anal fissure during its surgical treatment and perform the lateral internal sphincterotomy only can reduce the intensity of postoperative pain syndrome, the rate of postoperative complications and reduce the time of epithelialization of the anoderm defect.

Kronik anal fissür için anal Botulinium toksin enjeksiyonu: 224 hastadan oluşan retrospektif bir kohortta etkinlik ve güvenlik analizi

Backgorund and Aims: The aim of this retrospective study is to evaluate the relationship between the number of injection sites and healing outcomes in 224 patients with chronic anal fissure who underwent anal Botulinum toxin treatment. Materials and Methods: The medical records of 224 patients who received anal Botulinum toxin treatment for chronic anal fissure were retrospectively analyzed. Patients were categorized into three groups based on the number of injection sites: Group A (two injection sites, n = 34), Group B (three injection sites, n = 109), and Group C (four injection sites, n = 81). Each injection contains 20 IU of Botulinum toxin. Healing outcomes, pain reduction, wound healing, and symptom resolution were evaluated. A comprehensive analysis of patient records and clinical data was performed. Demographic information, treatment details, healing outcomes, and adverse events were assessed. Results: Cox regression analysis revealed a significant association between the number of injection sites and healing outcomes. At all three post-operative time points, patients treated at multiple sites (Group C) reported higher recovery levels compared to patients treated at two sites (Group A). Conclusion: This study demonstrated a significant relationship between the number of injection sites treated with anal Botulinum toxin and healing outcomes in patients with chronic anal fissures. These findings highlight the importance of considering the number of injection sites. The study contributes to the understanding of anal Botulinum toxin treatment for chronic anal fissure, emphasizing its potential to improve patient care and overall quality of life.

FTP2.5 Clinical audit following initial experience from a dedicated botox clinic for the treatment of anal fissure

Abstract Background and Aims Chronic anal fissure is a common and debilitating disease. Intersphincteric injection of Botulinum Toxin A during examination under anaesthesia (EUA) is an established treatment option following failed conservative management. The aim of this study was to investigate the effectiveness of clinic-based Botox injection for treatment of chronic anal fissure as an alternative to injection under anaesthesia. Feasibility was evaluated in terms of cost, safety and sustainability. Methods This was a retrospective single centre study of prospectively collected data between August 2021 and August 2022. Demographic data, treatment protocols and follow-up outcomes at three months were collated. The relative costs were provided by the regional financial department. Results Sixty-four patients were referred to clinic in the first year. Anal fissure was confirmed in 63% of patients with 89% receiving Botox injection in the clinic setting with no major complications. Healed fissure was induced in 85% of patients reviewed at a three-month follow-up. Five patients required referral for EUA with injection of botox. An estimated cost saving of £1,308.50 per case was achieved for clinic-based Botox versus Botox administered via EUA. Clinic-based administration of Botox reduced theatre resource utilisation during the study period. Conclusion Clinic-based Botox administration is feasible, safe and effective in the treatment of chronic anal fissure. This treatment approach not only provides a clinically effective, cost-efficient alternative to surgery but reduces resource utilisation and waste which is environmentally beneficial.

Botulinum toxin injection in outpatients for chronic anal fissure

Objectives The aim of the study was to evaluate the effect of botulinum toxin (BT) injection on fissure healing in the treatment of chronic anal fissure (CAF) in outpatient conditions without any analgesia and sedation to the internal anal sphincter (IAS). The primary outcome measure was post-procedural pain. The secondary outcome measures were fissure healing and complications. Methods Prospectively preserved data of 67 patients who received BT injections for CAF were analyzed prospectively. Demographic data, duration of symptomatic improvement, fissure location and number, parity, post-procedural pain, complications, continence status, response to treatment, and duration of follow-up were examined. Participants received bilateral (50 + 50 units) BT injections into the internal anal sphincter (IAS) in an outpatient setting. Results Symptomatic improvement was observed in 58% of patients within 1 week. The complete response rate to treatment was 82% at a mean follow-up of 6 months. Patients with partial response to treatment (10%) were successfully treated with topical therapy, and patients with persisting fissures (8%) were successfully treated with partial lateral internal sphincterotomy (LIS). 14 patients (21%) reported some degree of transient incontinence at follow-up. Multiparous women experienced more symptoms of Incontinence (p = 0.00). Pre- and post-procedural Vas Score median values were 4. The 7th-week VAS score median value was 3. Conclusion Dysport injection under sedation-free outpatient conditions is an effective and safe alternative to LIS for the treatment of CAF, with tolerable procedural pain. All patients should be warned of transient incontinence.

Applicability and results of surgical treatment of chronic anal fissures in the polyclinic

Applicability and results of surgical treatment of chronic anal fissures in the polyclinic

Topical Nitroglycerin versus Lateral fnternal Sphincterotomyin Treatment of Chronic Anal Fissure

Background: Anal fissure is common conditions that can affect people of all ages. Most anal fissures are at the rear of anal opening in line with cleft of the buttocks. There are many methods of treatment such as: medication by topical nitroglycerin or nifedipine paste or butulinum toxin injection or surgery by lateral internal Sphincterotomy or V-Y advancement flap.&#x0D; Objectives: Is to compare the result of topical GTN (chemical Sphincterotomy) as primary treatment of chronic anal fissure with lateral internal Sphincterotomy.&#x0D; Methods:&#x0D; Setting: In outpatient clinic and Tikrit teaching hospital from Jan. 2006 to Oct0.2007.&#x0D; Design: prospective study.&#x0D; This study compares the results of two different methods of treatment (chemical sphinecterotomy&amp;lateral internal Sphincterotomy) in 84 cases of chronic anal fissure regarding the efficacy and complication of these procedures.&#x0D; These cases were randomized in equal number into two groups:&#x0D; Group 1: were treated by chemical Sphincterotomy.&#x0D; Group 2: were treated by lateral internal Sphincterotomy.&#x0D; The average period of follow up after completion of treatment was 3 months for both groups.&#x0D; Results:&#x0D; Symptomatic improvement occurs in 30 patients treated by chemical Sphincterotomy (71.42%) at 12 weeks following treatment and 39 patients (92.85%) treated by lateral internal Sphincterotomy.&#x0D; No improvement occurs in 3 cases (7.15%) treated by chemical Sphincterotomy and no case who was treated by lateral internal Sphincterotomy.&#x0D; Conclusion: From this study we find that chemical Sphincterotomy induce rapid healing of chronic anal fissure with 71.42% rate in comparison to lateral internal Sphincterotomy with a 92.85% healing rate after 12 weeks treatment,

Comparison of Botulinum Toxin Injection and Botulinum Toxin Injection with Glyceryl Trinitrate for Treatment of Chronic Anal Fissure

Anal fissure (AF) is an illness of anal canal and is characterized by cracks appearing in stratified squamous epithelium of distal anal canal. The tear, being present in the squamous part of the epithelium, causes considerable pain, fresh bleeding while defecation. The current study is planned to compare the Botulinum toxin Injection and botulinum toxin Injection with Glyceryl trinitate for the treatment of chronic anal fissure in terms of healing. Materials and Methods: Patients will be sent home after one hour with stool softener .while patients in group B will be will receive treatment with 0.2 ml (20 units) Botulinum toxin injection plus 1 gram 0.2% topical glyceryl trinitate cream 8 hourly with dose of 1 gram on middle fingers tip and apply it 1 cm2 in anal canal circumferentially. In both groups, patients will be assessed at follow up after 2 , 4 and 8 weeks post treatment. At follow up, patients will be examined for healing (yes or no) and any other side effect will be documented. Results: In Botulinum toxin injection group, 26(78.8%) had wound healing after 2 months and 30(90.9%) in Botulinum toxin injection with glyceryl trinitrate group with a p-value = 0.170. Conclusion: Botulinum toxin injection with glycerylyl trinitrate is a better technique for treatment of chronic anal fissure healing in comparison with Botulinum toxin injection alone. Keywords: Chronic Anal Fissure, Treatment, Botulinum Injection, Botilinum Injection with Glyceyl Trintrate, Comparison

Fissurectomy versus lateral internal sphincterotomy in the treatment of chronic anal fissures: no advantages in terms of post-operative incontinence

PurposeThe standard treatment for chronic anal fissures that have failed non-operative management is lateral internal sphincterotomy. Surgery can cause de novo incontinence. Fissurectomy has been proposed as a sphincter/saving procedure, especially in the presence of a deep posterior pouch with or without a crypt infection. This study investigated whether fissurectomy offers a benefit in terms of de novo post-operative incontinence.MethodsPatients surgically managed with fissurectomy or lateral internal sphincterotomy for chronic anal fissures from 2013 to 2019 have been included. Healing rate, changes in continence and patient satisfaction were investigated at long-term follow-up.ResultsOne hundred twenty patients (55 females, 65 males) were analysed: 29 patients underwent fissurectomy and 91 lateral internal sphincterotomy. Mean follow-up was 55 months [confidence interval (CI) 5–116 months]. Both techniques showed some rate of de novo post-operative incontinence (> +3 Vaizey score points): 8.9% lateral internal sphincterotomy, 17.8% fissurectomy (p = 0.338). The mean Vaizey score in these patients was 10.37 [standard deviation (sd) 6.3] after lateral internal sphincterotomy (LIS) and 5.4 (sd 2.3) after fissurectomy Healing rate was 97.8% in the lateral internal sphincterotomy group and 75.8% in the fissurectomy group (p = 0.001). In the lateral internal sphincterotomy group, patients with de novo post-op incontinence showed a statistically significant lower satisfaction rate (9.2 ± 1.57 versus 6.13 ± 3; p = 0.023) while no differences were present in the fissurectomy group (8.87 ± 1.69 versus 7.4 ± 1.14; p = 0.077).ConclusionsLateral internal sphincterotomy is confirmed as the preferred technique in term of healing rate. Fissurectomy did not offer a lower rate of de novo post-operative incontinence, but resulted in lower Vaizey scores in patients in whom this occurred. Satisfaction was lower in patients suffering a de novo post-operative incontinence after lateral internal sphincterotomy.