Article Type

Original Study


Objective The aim of this study was to compare the results of lateral internal anal sphincterotomy up to the dentate line or up to the apex of the anal fissure. Background Troublesome fecal incontinence following a lateral internal sphincterotomy is often attributed to faulty surgical technique. However, it may be associated with coexisting occult sphincter defects. Whether continence is related to the extent of sphincterotomy remains debatable. Patients and methods This prospective randomized study included 48 patients suffering from chronic anal fissures in the period between October 2013 and March 2015. They were admitted to the Department of Surgery of Menoufia University and Al-Helal insurance hospitals. This study included 24 patients who underwent traditional lateral internal sphincterotomy (up to the dentate line) and 24 patients who underwent conservative lateral internal anal sphincterotomy (up to the height of the fissure apex or just below it). All patients were evaluated with respect to operative time and postoperative complications. The results were documented and statistically analyzed. Results The mean time required for relief of pain postoperatively after conventional lateral sphincterotomy (LS) operation was 2.1 ± 2.6 days and that after conservative LS was 3.7 ± 3.5 days. Early transient incontinence was reported in 9/24 (37.5%) patients in the conventional LS group and 2/24 (4.2%) patients in the conservative LS group. Wounds healed within 6 weeks in 16/24 (66.7%) patients of the conventional LS group and in 22/24 (95.8%) patients of the conservative LS group. Conclusion On the basis of this study, we conclude that the conservative LS operation has several advantages over the conventional LS operation in the treatment of chronic anal fissures.