Retrospective comparative evaluation of anal fissure treatment methods: superficial posterior internal sphincterotomy and lateral internal sphincterotomy in our own patient population

*Przemysław Ciesielski^{1, 2}, Agnieszka Kucharczyk², Małgorzata Kołodziejczak², Paweł Dutkiewicz¹, Sylwia Mossakowska¹

Summary
Introduction. Among the numerous methods of anal fissure treatment two have been established for many years: superficial posterior sphincterotomy and left lateral severing of the internal anal sphincter. The results of the treatment of patients with both methods described in the literature are comparable and reports of the duration of healing, perioperative pain and complications in the form of gas and stool incontinence do not differ in a significant way.
Aim. The aim of the paper was to conduct retrospective comparative evaluation of anal fissure treatment methods: superficial posterior internal sphincterotomy and lateral internal sphincterotomy in the authors’ own patient population.
Material and methods. All patients who underwent surgery for chronic anal fissure in 2012-2015 at the Department of Surgery of the Hospital in Wołomin, Poland, were included in the analysis. 97 patients in total underwent surgery (42 men, 55 women). In 14 patients lateral internal sphincterotomy was performed and in the remaining 83 patients superficial posterior sphincterotomy with fissurectomy was performed.
Results. The rate of relapse and incontinence was higher in the group of patients who underwent fissurectomy with superficial posterior sphincterotomy (7 vs 1%); the rate of incontinence was also higher (5 vs 1%). The intensity of pain (averaged) before the operation was comparable (VAS: 7 points).
Conclusions. 1. In the studied group better treatment results were achieved by using lateral internal sphincterotomy. 2. Due to the retrospective nature of the paper as well as lack of baseline and postoperative assessment of sphincter function parameters using anorectal manometry, the results of the study should be treated as preliminary data which require confirmation in a prospective study with sphincterometry assessment before the surgery.

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