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Open vs. Closed Lateral Internal Sphincterotomy for Idiopathic Fissure-in-Ano: A Prospective, Randomized, Controlled Trial

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  • Published:
Diseases of the Colon & Rectum

PURPOSE:

Internal sphincterotomy remains the “gold standard” for treatment of anal fissure but is associated with a risk of imperfect continence. Recent studies have suggested that surgical technique (open vs. closed) may influence incontinence rates after sphincterotomy. This study was designed to assess the short-term and long-term incidence of incontinence after open and closed internal sphincterotomy.

METHODS:

Seventy-nine patients were randomly assigned to open or closed internal sphincterotomy, performed in standardized fashion by trainee staff. Standardized questionnaires assessing continence (modified Wexner score) were administered preoperatively and at 1, 6, and 52 weeks. Postoperative stay, pain scores, complications, and fissure healing were prospectively assessed by an independent observer.

RESULTS:

Three patients were lost to follow-up, leaving 36 closed (16 males; mean age, 45.1 years) and 40 open (21 males; mean age, 47.9 years) internal sphincterotomy patients for assessment. All operations were performed as day case procedures with no readmissions. At six weeks postoperative, 96 percent of fissures had healed. There were no significant differences in pain scores between closed and open internal sphincterotomy at Day 1 or Day 3 postoperative. New incontinence of any grade was seen in 6.8 percent of patients at 52-week follow-up. Three patients (4.1 percent, 1 closed, 2 open) suffered major incontinence at 52 weeks. There were no significant differences in continence at 1, 6, or 52 weeks, although more open patients experienced minor imperfections at 1 week.

CONCLUSIONS:

Incontinence after internal sphincterotomy is not insignificant. The technique (closed vs. open) does not seem to influence incontinence rates.

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REFERENCES

  1. WR Schouten JW Briel JJ Auwerda (1994) ArticleTitleRelationship between anal pressure and anodermal blood flow: the vascular pathogenesis of anal fissures Dis Colon Rectum 37 664–9

    Google Scholar 

  2. J Olsen PE Mortensen I Krogh Petersen J Christiansen (1987) ArticleTitleAnal sphincter function after treatment of fissure-in-ano by lateral subcutaneous sphincterotomy versus anal dilatation. A randomized study Int J Colorectal Dis 2 155–7

    Google Scholar 

  3. P Prohm C Bonner (1995) ArticleTitleIs manometry essential for surgery of chronic fissure-in-ano? Dis Colon Rectum 38 735–8

    Google Scholar 

  4. N Williams NA Scott MH Irving (1995) ArticleTitleEffect of lateral sphincterotomy on internal anal sphincter function: a computerized vector manometry study Dis Colon Rectum 38 700–4

    Google Scholar 

  5. SR Gorfine (1995) ArticleTitleTopical nitroglycerin therapy for anal fissures and ulcers N Engl J Med 333 1156–7

    Google Scholar 

  6. JN Lund JH Scholefield (1997) ArticleTitleA randomised prospective double blind placebo controlled trial of glyceryl trinitrate ointment in the treatment of anal fissure Lancet 349 11–4

    Google Scholar 

  7. WH Jost (1997) ArticleTitleOne hundred cases of anal fissure treated with botulinum toxin: early and long-term results Dis Colon Rectum 40 1029–32

    Google Scholar 

  8. WH Jost K Schimrigk (1994) ArticleTitleTherapy of anal fissure using botulin toxin Dis Colon Rectum 37 1340

    Google Scholar 

  9. WH Isbister J Prasad (1995) ArticleTitleFissure in ano ANZ J Surg 65 107–8

    Google Scholar 

  10. DC Hoffmann JC Goligher (1970) ArticleTitleLateral subcutaneous internal sphincterotomy in treatment of anal fissure BMJ 3 673–5

    Google Scholar 

  11. JE Ray JC Penfold JB Gathright SH Roberson (1974) ArticleTitlePresidential address. Lateral subcutaneous internal anal sphincterotomy for anal fissure Dis Colon Rectum 17 139–44

    Google Scholar 

  12. A Parks (1967) ArticleTitleThe management of fissure in ano Hosp Med 1 737

    Google Scholar 

  13. MJ Notaras (1969) ArticleTitleLateral subcutaneous sphincterotomy for anal fissure-a new technique Proc R Soc Med 62 713

    Google Scholar 

  14. ML Kennedy H Nguyen DZ Lubowski DW King (1996) ArticleTitleStimulated gracilis neosphincter: a new procedure for anal incontinence ANZ J Surg 66 353–7

    Google Scholar 

  15. J Jorge S Wexner (1993) ArticleTitleThe etiology and management of fecal incontinence Dis Colon Rectum 36 77–97

    Google Scholar 

  16. TA Cook MM Humphreys NJ McMortensen (1999) ArticleTitleOral nifedipine reduces resting anal pressure and heals chronic anal fissure Br J Surg 86 1269–73

    Google Scholar 

  17. PR Hawley (1969) ArticleTitleThe treatment of chronic fissure-in-ano. A trial of methods Br J Surg 56 915–8

    Google Scholar 

  18. SL Jensen F Lund OV Nielsen G Tange (1984) ArticleTitleLateral subcutaneous sphincterotomy versus anal dilatation in the treatment of fissure in ano in outpatients: a prospective randomised study Br Med J (Clin Res Ed) 289 528–30

    Google Scholar 

  19. M Marby J Alexander-Williams P Buchmann et al. (1979) ArticleTitleA randomized controlled trial to compare anal dilatation with lateral subcutaneous sphincterotomy for anal fissure Dis Colon Rectum 22 308–11

    Google Scholar 

  20. RM Weaver NS Ambrose J Alexander-Williams MR Keighley (1987) ArticleTitleManual dilatation of the anus vs. lateral subcutaneous sphincterotomy in the treatment of chronic fissure-in-ano: results of a prospective, randomized, clinical trial Dis Colon Rectum 30 420–3

    Google Scholar 

  21. RC Bennett JC Goligher (1962) ArticleTitleResults of internal sphincterotomy for anal fissure BMJ 5318 1500–3

    Google Scholar 

  22. PB Boulos JG Araujo (1984) ArticleTitleAdequate internal sphincterotomy for chronic anal fissure: subcutaneous or open technique? Br J Surg 71 360–2

    Google Scholar 

  23. JB Kortbeek JM Langevin RE Khoo JA Heine (1992) ArticleTitleChronic fissure-in-ano: a randomized study comparing open and subcutaneous lateral internal sphincterotomy Dis Colon Rectum 35 835–7

    Google Scholar 

  24. C Oh CM Divino RM Steinhagen (1995) ArticleTitleAnal fissure: 20-year experience Dis Colon Rectum 38 378–82

    Google Scholar 

  25. BJ Pernikoff TE Eisenstat RJ Rubin GC Oliver EP Salvati (1994) ArticleTitleReappraisal of partial lateral internal sphincterotomy Dis Colon Rectum 37 1291–5

    Google Scholar 

  26. V Usatoff AL Polglase (1995) ArticleTitleThe longer term results of internal anal sphincterotomy for anal fissure ANZ J Surg 65 576–8

    Google Scholar 

  27. TH Lewis ML Corman ED Prager WG Robertson (1988) ArticleTitleLong-term results of open and closed sphincterotomy for anal fissure Dis Colon Rectum 31 368–71

    Google Scholar 

  28. DZ Lubowski DW King (1995) ArticleTitleObstructed defecation: current status of pathophysiology and management ANZ J Surg 65 87–92

    Google Scholar 

  29. J Garcia-Aguilar C Belmonte WD Wong AC Lowry RD Madoff (1996) ArticleTitleOpen vs. closed sphincterotomy for chronic anal fissure: long-term results Dis Colon Rectum 39 440–3

    Google Scholar 

  30. N Hananel PH Gordon (1997) ArticleTitleLateral internal sphincterotomy for fissure-in-ano—revisited Dis Colon Rectum 40 597–602

    Google Scholar 

  31. M Jonas JH Scholefield (2001) ArticleTitleAnal fissure Gastroenterol Clin North Am 30 167–81

    Google Scholar 

  32. IT Khubchandani JF Reed (1989) ArticleTitleSequelae of internal sphincterotomy for chronic fissure in ano Br J Surg 76 431–4

    Google Scholar 

  33. DR Littlejohn GL Newstead (1997) ArticleTitleTailored lateral sphincterotomy for anal fissure Dis Colon Rectum 40 1439–42

    Google Scholar 

  34. G Milito A Arullani C Brancaleone D Cesca V Filingeri CU Casciani (1983) ArticleTitleSubcutaneous lateral internal sphincterotomy in the treatment of chronic anal fissure Ital J Surg Sci 13 275–9

    Google Scholar 

  35. DC Nyam JH Pemberton (1999) ArticleTitleLong-term results of lateral internal sphincterotomy for chronic anal fissure with particular reference to incidence of fecal incontinence Dis Colon Rectum 42 1306–10

    Google Scholar 

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Authors and Affiliations

  1. Colorectal Surgical Units, Royal Adelaide Hospital, Adelaide, Australia

    M. Wiley F.R.A.C.S., P. Day F.R.A.C.S., J. Stephens B.Sc., (Hons) & J. Moore F.R.A.C.S.

  2. The Queen Elizabeth Hospital, Adelaide, Australia

    N. Rieger F.R.A.C.S. & J. Stephens B.Sc., (Hons)

  3. Department of Surgery, University of Adelaide, Adelaide, Australia

    N. Rieger F.R.A.C.S. & J. Moore F.R.A.C.S.

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  1. M. Wiley F.R.A.C.S.
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  2. P. Day F.R.A.C.S.
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  3. N. Rieger F.R.A.C.S.
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  4. J. Stephens B.Sc., (Hons)
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Correspondence to J. Moore F.R.A.C.S..

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Wiley, M., Day, P., Rieger, N. et al. Open vs. Closed Lateral Internal Sphincterotomy for Idiopathic Fissure-in-Ano: A Prospective, Randomized, Controlled Trial. Dis Colon Rectum 47, 847–852 (2004). https://doi.org/10.1007/s10350-004-0530-2

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  • DOI: https://doi.org/10.1007/s10350-004-0530-2

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