Type of lateral internal sphincterotomy incision: parallel or vertical?

Area of Science:

• Colorectal Surgery
• Surgical Techniques
• Wound Healing

Background:

• Chronic anal fissures (CAFs) are often treated with lateral internal sphincterotomy (LIS).
• Optimal surgical technique for LIS, specifically anoderm incision type, requires further investigation.
• This study compares vertical versus parallel anoderm incisions in open LIS for CAFs.

Purpose of the Study:

• To evaluate the impact of anoderm incision orientation on wound healing.
• To compare wound-related complications, incontinence, and recurrence rates between vertical and parallel incisions in LIS.
• To determine the optimal anoderm incision technique for LIS in CAF patients.

Main Methods:

• Prospective randomized clinical study involving 52 patients with CAFs undergoing open LIS.
• Patients were divided into two groups: vertical anoderm incision (n=25) and parallel anoderm incision (n=27).
• Outcomes assessed included wound complications, healing time, itching, incontinence, and recurrence; incisions were unsutured.

Main Results:

• No significant differences in overall wound complications, incontinence, or recurrence rates between the groups.
• Patients with vertical incisions experienced significantly longer itching duration (p<0.0001).
• Wound healing was significantly slower in the vertical incision group (19.44 days) compared to the parallel incision group (10.59 days, p<0.0001).

Conclusions:

• Anoderm incisions made parallel to the anus significantly reduce wound healing time.
• Parallel incisions also lead to a significant reduction in the duration of perianal itching post-LIS.
• The parallel incision technique may be preferable for optimizing recovery after LIS for CAFs.