[Surgical treatment of anal fissure]

Anal fissure is very painful; surgery is warranted when medical treatment fails.

We present a retrospective study of 34 patients (median age 42; 19-63) treated by subcutaneous lateral internal sphincterotomy (n = 27) and anal dilatation (n = 7) from 1992 to 2002, carried out by a questionnaire on pain, anal incontinence, and treatment result.

There were no complications or treatment for recurrence of anal fissure. Median pain score before surgery was 7.3 on a scale from 0 (no pain) to 10 (worst imaginable pain), median 73 months (4-124) after surgery the median score was 0 (0-5) (p = 0.00). For sphincterotomy (n = 27), the median score was 7.8 before surgery and 0 (0-5) after (p = 0.00), for anal dilatation 6 (3-10) before surgery and 2 (0-2) (p = 0.01) after. All patients had reduced pain scores after surgery but their incontinence scores remained unchanged. Two patients (7%) who had previously been dilated or irradiated developed faecal incontinence after sphincterotomy. More patients became asymptomatic after sphincterotomy (n = 18; 67%) than after anal dilatation (n = 4; 57%).

Compared to anal dilatation, sphincterotomy offers better pain relief for anal fissure. Doing a shorter sphincterotomy corresponding to length of the fissure reduces the risk of anal incontinence.