OPEN VS CLOSED SPHINCTEROTOMY FOR CHRONIC ANAL-FISSURE - LONG-TERM RESULTS

PURPOSE: This study was undertaken to compare the healing rate and lon g-term effects on continence of open and closed lateral internal sphin cterotomy. METHODS: Charts of 864 patients with chronic anal fissure w ho underwent internal sphincterotomy as a single procedure over five y ears by a group of 12 colorectal surgeons were reviewed. Open internal sphincterotomy (OIS) was performed in 521 patients, whereas 343 had c losed internal sphincterotomy (CIS). There was no difference in sex or age between the groups. A questionnaire inquiring about clinical outc ome, changes in continence, and degree of satisfaction with the proced ure was mailed to all patients. A total of 549 (63.5 percent) patients , 324 (62.2 percent) with OIS and 225 (65.6 percent) with CIS, returne d their questionnaires. Average followup was three (range, 1-6) years. RESULTS: Differences in persistence of symptoms (3.4 OIS vs. 5.3 perc ent CIS), recurrence of the fissure (10.9 vs. 11.7 percent CIS), and n eed for reoperation (3.4 percent OIS vs. 4 percent CIS) were statistic ally not significant. However, statistically significant differences w ere seen in the percentage of patients with permanent postoperative di fficulty controlling gas (30.3 vs. 23.6 percent; P 0.062), soiling und erclothing (26.7 trs. 16.1 percent; P < 0.001), and accidental bowel m ovements (11.8 vs. 3.1 percent; P < 0.001) between those who underwent OIS and those who had CIS. Although 90 percent of patients reported g eneral overall satisfaction, more patients undergoing CIS (64.4 percen t) than OIS (49.7 percent) were very satisfied with the results of the procedure. CONCLUSIONS: Lateral internal sphincterotomy is highly eff ective in treatment of chronic anal fissure but is associated with sig nificant permanent alterations in continence. CIS is preferable to OIS because it effects a similar rate of cure with less impairment of con trol.