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Operative procedures for fissure in ano.
1Surgery, University of Illinois, 1740 West Taylor, Room 2204 m/c 957, Chicago, Illinois 60612, USA. altohorn@uic.edu
The Cochrane Database of Systematic Reviews
|April 23, 2005
Summary
For anal fissure surgery, anal stretch and posterior midline sphincterotomy are not recommended. Open and closed partial lateral internal sphincterotomy are equally effective for treating anal fissures.
Area of Science:
- Colorectal Surgery
- Surgical Outcomes Research
Background:
- Common anal fissure surgeries include anal stretch, open/closed lateral sphincterotomy, and posterior midline sphincterotomy.
- Existing comparative studies have variable results and potential biases.
Purpose of the Study:
- To determine the optimal surgical technique for anal fissure treatment.
Main Methods:
- A systematic review and meta-analysis of 24 trials (3475 patients) comparing operative techniques for anal fissure.
- Searched Cochrane Central Register of Controlled Trials and MEDLINE (1965-2005).
- Primary endpoints were fissure persistence and postoperative flatus incontinence.
Main Results:
- Anal stretch showed higher rates of fissure persistence and incontinence compared to internal sphincterotomy.
- Open and closed partial lateral internal sphincterotomy demonstrated similar efficacy in fissure healing and incontinence rates.
Conclusions:
- Anal stretch and posterior midline internal sphincterotomy should be discontinued for chronic anal fissure treatment.
- Open and closed partial lateral internal sphincterotomy are equally effective surgical options.
- Further research is needed for other techniques like anterior levatorplasty and papilla excision.