Diseases of the Colon & Rectum

, Volume 38, Issue 4, pp 378–382 | Cite as

Anal fissure

20-Year experience
  • Changyul Oh
  • Celia M. Divino
  • Randolph M. Steinhagen
Original Contributions


PURPOSE: This study was designed to review a 20-year experience of the treatment of patients with anal fissure to identify possible etiologic factors and to explore effective preventative measures and the ideal treatment for this disease. METHODS: From January 1972 to December 1991, 1,391 patients (700 males, 691 females; average age, 39 years) with chronic symptomatic anal fissures underwent surgical treatment using either open or closed techniques. The following procedures were performed: 1) internal sphincterotomy for 1,313 idiopathic fissures; 2) C-anoplasty for 36 cases of anal stricture; 3) debridement and sphincterotomy for 25 patients with postsurgical nonhealing wounds; 4) bilateral excision of the protruding internal sphincter for 17 patients with “subluxation.” Acute superficial anal fissures were treated conservatively, with emphasis on anal hygiene. RESULTS: Acute superficial anal fissures responded well to conservative management. Over 95 percent of patients with chronic anal fissures treated by surgery had satisfactory relief of symptoms. Early complications included urinary retention (1.4 percent), bleeding (1.1 percent), and abscess and fistula formation (0.7 percent). Late complications manifested as flatus and liquid incontinence (1.5 percent), delayed wound healing (1.4 percent), recurrence of fissures (1.3 percent), and symptomatic itching and burning (1.1 percent). The complication rate was higher in the group that underwent closed sphincterotomy than in the group treated by open techniques. CONCLUSIONS: Proper anal hygiene is important in both prevention and initial conservative management of symptomatic anal fissures. For chronic intractable cases, open lateral internal sphincterotomy is strongly recommended. C-anoplasty should be done when strictures are present. Excision of the protruding internal sphincter is recommended in patients who present with an excessively elongated, tight anal canal with a partially protruding internal sphincter.

Key words

Anal fissure Anus Anal sphincter Colon and rectal surgery 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Oh C. Lateral subcutaneous internal sphincterotomy for anal fissure. Mt Sinai J Med 1975;42:596–601.PubMedGoogle Scholar
  2. 2.
    Oh C. A modified technique for lateral internal sphincterotomy. Surg Gynecol Obstet 1978;146:623–5.PubMedGoogle Scholar
  3. 3.
    Oh C, Zinberg J. Anoplasty for anal stricture. Dis Colon Rectum 1982;25:809–10.PubMedGoogle Scholar
  4. 4.
    Oh C. Surgical management of protruding anus. Coloproctology 1991;13:379–82.Google Scholar
  5. 5.
    Arnous J, Denis J. Pathogenesis and concepts of anal fissure. Am J Proctol 1971;22:184–6.PubMedGoogle Scholar
  6. 6.
    Schrock T, Cerra F, Hawley PR, Hunt TK, Nichols RL, Samson RB. Symposium: wounds and wound healing. Dis Colon Rectum 1982;25:1–15.PubMedGoogle Scholar
  7. 7.
    Hicks TC, Timmcke AE. Fissure-in-ano. In: Zuidema GD, Condon RE, eds. Shackelford's surgery of the alimentary tract, 3rd ed, Vol. IV. Philadelphia: WB Saunders, 1991:286–93.Google Scholar
  8. 8.
    Eisenhammer S. The surgical correction of chronic anal (sphincteric) contracture. S Afr Med J 1951;25:486–9.PubMedGoogle Scholar
  9. 9.
    Bennett RC, Goligher JC. Results of internal sphincterotomy for anal fissure. BMJ 1962;2:1500–3.PubMedGoogle Scholar
  10. 10.
    Magee HR, Thompson HR. Internal anal sphincterotomy as an out-patient operation. Gut 1966;7:190–3.PubMedGoogle Scholar
  11. 11.
    Hardy KJ. Internal sphincterotomy: an appraisal with special reference to sequelae. Br J Surg 1967;54:30–1.PubMedGoogle Scholar
  12. 12.
    Notaras MJ. Lateral subcutaneous sphincterotomy for anal fissure: a new technique. J R Soc Med 1969;62:713.Google Scholar
  13. 13.
    Hawley PR. The treatment of chronic fissure-in-ano: a trial of methods. Br J Surg 1969;56:915–8.PubMedGoogle Scholar
  14. 14.
    Hoffman DC, Goligher JC. Lateral subcutaneous internal sphincterotomy in treatment of anal fissure. BMJ 1970;3:673–5.CrossRefGoogle Scholar
  15. 15.
    Oh C. Inflammatory and neoplastic diseases of the anal and perianal regions. Clin Dermatol 1987;5:87–102.PubMedGoogle Scholar
  16. 16.
    Oh C. The role of internal sphincterotomy. Mt Sinai J Med 1982;49:484–6.PubMedGoogle Scholar
  17. 17.
    Lacitignola S. Treatment of anal fissure using Parks' method modified by Oh. Colo-proctology 1987;9:270–2.Google Scholar
  18. 18.
    Nickell WB, Woodward ER. Advancement flaps for treatment of anal stricture. Arch Surg 1972;104:223–4.PubMedGoogle Scholar
  19. 19.
    Sarner JB. Plastic relief of anal stenosis. Dis Colon Rectum 1969;12:277–80.PubMedGoogle Scholar

Copyright information

© American Society of Colon and Rectal Surgeons 1995

Authors and Affiliations

  • Changyul Oh
    • 1
  • Celia M. Divino
    • 1
  • Randolph M. Steinhagen
    • 1
  1. 1.Department of SurgeryMount Sinai Medical CenterNew York

Personalised recommendations