Operative procedures for fissure in ano

Area of Science:

• Colorectal surgery
• Gastroenterology
• Surgical outcomes

Background:

• Common anal fissure surgeries include anal stretch, open/closed lateral sphincterotomy, and posterior midline sphincterotomy.
• Existing comparative studies have variable results due to bias and small sample sizes.
• Efficacy of different surgical techniques for anal fissure requires robust comparison.

Purpose of the Study:

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

Main Methods:

• A systematic review and meta-analysis of comparative studies on anal fissure surgery.
• Searched Cochrane Controlled Trials Register and MEDLINE (1965-2000).
• Included studies directly comparing at least two operative techniques, obtaining crude data when necessary. Primary endpoints were fissure persistence and postoperative flatus incontinence.

Main Results:

• Anal stretch demonstrated higher rates of fissure persistence and minor incontinence compared to internal sphincterotomy.
• Open and closed partial lateral internal sphincterotomy showed comparable outcomes regarding fissure persistence and incontinence.
• Posterior midline sphincterotomy's efficacy remains uncertain due to limited data.

Conclusions:

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