[Partial left lateral subcutaneous sphincterotomy for anal fissure: role and results]

This is a retrospective analysis of the results obtained with surgical treatment consisting in left lateral partial subcutaneous sphincterotomy for anal fissure. Fifty patients observed from January 2002 to June 2005 in our Coloproctology outpatients' department were recruited. Five patients (10%) did not undergo an operation and all 5 presented an acute anal fissure. Their treatment was conservative consisting in fibre ingestion, use of stool softeners, ointments, anti-inflammatory agents after opening the bowel, and a corticosteroid ointment. Forty-five patients (90%) were operated on. Twelve of these (26%) were operated on for an acute anal fissure after early failure of conservative therapy and demanded immediate surgical therapy; 14 (31%) of those operated on for acute anal fissure underwent a surgical procedure after at least a month of conservative treatment. The remaining 19 patients (42%) presented chronic anal fissures, with symptoms lasting more than 1 month and with sentinel haemorrhage, a hypertrophied anal papilla, and hardening of the edge of the fissures. Forty of the patients operated on (88%) presented a posterior anal fissure, 3 patients (6.5%) an anterior anal fissure and 2 patients (4.5%) synchronous anterior and posterior anal fissures. The surgical procedure carried out on all patients undergoing operation was a partial left lateral subcutaneous internal sphincterotomy using the closed technique according to Notoras under general anaesthesia. Follow-up was carried out 15 days and 2, 3 and 6 months postoperatively. The results were considered very good in 89% of the cases, while 5 patients (11%) complained of pain after opening the bowels, albeit of acceptable intensity and such as not to require another operation or significant pharmacological treatment. No complications were observed. The conclusion after the analysis of our experience is in agreement with the 8th recommendation, class I, recommendation grade A of the "The Standards Practice Task Force of the American Society of Colon and Rectal Surgeons" stating that "surgery may be appropriately offered without a trial of pharmacologic treatment after failure of conservative therapy" and that "in our experience can be proposed in those cases of acute anal fissure". In our experience, the 89% success rate and substantial patient satisfaction make this procedure more appropriate than medical treatment and alternative surgical treatments.