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Updated: May 27, 2026
08:09
Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
Operative procedures for fissure in ano
Richard L Nelson1, Arpita Chattopadhyay, William Brooks
1Department of General Surgery, Northern General Hospital, Sheffield, UK. Rick.Nelson@sth.nhs.uk
The Cochrane Database of Systematic Reviews
|November 11, 2011
Summary
Manual anal stretch is not recommended for anal fissure surgery due to higher risks of recurrence and incontinence. Open and closed lateral internal sphincterotomy are equally effective surgical options for anal fissures.
Area of Science:
- Colorectal Surgery
- Surgical Gastroenterology
Background:
- Operative techniques for anal fissure yield variable results.
- Existing comparative studies suffer from bias or insufficient patient numbers.
Purpose of the Study:
- To determine the optimal surgical technique for anal fissure treatment.
- To compare the efficacy and safety of various operative procedures.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials (RCTs).
- Searched Cochrane, MEDLINE, PubMed, and Embase databases up to March 2011.
- Included 27 studies with 2056 patients comparing 13 operative procedures.
Main Results:
- Manual anal stretch has a higher risk of fissure recurrence and incontinence compared to internal sphincterotomy.
- Open and closed partial lateral internal sphincterotomy show similar efficacy and incontinence rates.
- Unilateral internal sphincterotomy has higher failure rates than bilateral, without increased incontinence.
Conclusions:
- Manual anal stretch 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 posterior internal sphincterotomy, levatorplasty, wound suture, and papilla excision.
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