Operative procedures for fissure in ano

Area of Science:

• Colorectal surgery
• Gastroenterology
• Surgical outcomes

Background:

• Common operative techniques for anal fissure include anal stretch, open/closed lateral sphincterotomy, and posterior midline sphincterotomy.
• Existing comparative studies on anal fissure surgery have limitations including bias and insufficient patient numbers.
• Efficacy of different surgical approaches for anal fissure requires further investigation.

Purpose of the Study:

• To determine the optimal surgical technique for anal fissure treatment.
• To compare the efficacy and safety of various operative methods for anal fissures.

Main Methods:

• A systematic literature search was conducted using MEDLINE and the Cochrane Library with keywords 'surgery, anal fissure'.
• Comparative studies directly comparing at least two operative techniques for anal fissure were reviewed.
• Data on fissure persistence and postoperative flatus incontinence were collected and analyzed.

Main Results:

• Anal stretch is associated with a higher risk of fissure persistence and minor incontinence compared to internal sphincterotomy.
• Open and closed partial lateral internal sphincterotomy demonstrate comparable rates of fissure persistence and incontinence.
• Limited data exist on the effectiveness of posterior internal sphincterotomy.

Conclusions:

• Anal stretch and posterior midline internal sphincterotomy should be discontinued for adult chronic anal fissure treatment.
• Open and closed partial lateral internal sphincterotomy are equally effective surgical options for anal fissures.
• Further research is needed to evaluate the effectiveness of posterior internal sphincterotomy.