Operative procedures for fissure in ano

Area of Science:

• Colorectal surgery
• Gastroenterology

Background:

• Common surgical techniques for anal fissure include anal stretch, open/closed lateral sphincterotomy, and posterior midline sphincterotomy.
• Previous comparative studies have yielded variable results due to bias and small sample sizes.

Purpose of the Study:

• To determine the optimal surgical technique for anal fissure treatment.

Main Methods:

• A systematic review and meta-analysis of controlled trials comparing operative techniques for anal fissure.
• Searched Cochrane, MEDLINE, PubMed, and Embase databases up to July 2008.
• Included 24 trials with 3475 patients, focusing on fissure persistence and postoperative incontinence.

Main Results:

• Anal stretch is associated with higher rates of fissure persistence and minor incontinence compared to internal sphincterotomy.
• Open and closed partial lateral internal sphincterotomy demonstrate comparable efficacy in terms of fissure healing and incontinence rates.

Conclusions:

• Anal stretch and posterior midline internal sphincterotomy should be avoided 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 posterior internal sphincterotomy and anterior levatorplasty.