Fissurectomy with posterior midline sphincterotomy for management of chronic anal fissure.

OBJECTIVE To determine the efficacy and safety of fissurectomy with posterior midline sphincterotomy in the management of chronic anal fissure in terms of symptomatic relief, complications and recurrence. STUDY DESIGN Observational case-series. PLACE AND DURATION OF STUDY Department of Surgery, Liaquat University Hospital, Jamshoro/Hyderabad, for a period of 3 years from January 2005 to December 2007. METHODOLOGY A total of 136 patients with chronic anal fissure were recruited for this study. All subjects underwent elective fissurectomy and posterior sphincterotomy. Surgery was performed either under spinal or general anaesthesia. Symptomatic relief and early postoperative complications were recorded. The patients were followed for 18 months. Follow-up included assessment for complications such as pain, incontinence, keyhole deformity, and recurrence. RESULTS All patients presented with pain during and after defaecation. Forty (29.4%) patients presented with bleeding per rectum. One hundred and sixteen (85%) patients complained of perianal swelling while 8 (5.9%) patients complained of perianal itching. Retention of urine was the most common postoperative complication, seen in 10 (7.4%) cases. It occurred within the first 24 hours after operation and all cases required catheterization. Six (4.4%) patients complained of moderate to severe postoperative pain in the first 24 hours, requiring narcotic analgesics. Transient incontinence of flatus and faeces occurred in 5 (3.7%) and 3 (2.2%) cases respectively. One patient presented with a recurrent anal fissure after 8 months but responded to conservative treatment. CONCLUSION Given the low rate of complications and almost negligible rate of recurrence, fissurectomy with posterior midline sphincterotomy is still a treatment of choice for the management of chronic anal fissure.