OUTPATIENT SURGICAL-TREATMENT OF ANAL-FISSURE

Objectives: To review our experience of treating anal fissures by late ral subcutaneous anal sphincterotomy in the outpatient clinic. Design: Retrospective study. Setting: University hospital, Israel. Subjects: 108 of 112 Consecutive patients with anal fissures. Interventions: All patients had failed to respond to a two week course of conservative t reatment. They all underwent lateral subcutaneous anal sphincterotomy under local anaesthesia in either the outpatient clinic or the day-cas e operating theatre. Main outcome measures: Early and late morbidity, patient satisfaction, admission to hospital, and recurrence. Results: 108 of the 112 were followed up for a mean of 20 months (range 2-56). 100 (93%) reported that the late results were good to excellent. Four patients bled immediately after the operation and required admission t o hospital and four developed abscesses of which only one responded to conservative treatment: 14 patients complained of initial mild incont inence but in most this resolved over time: 92, patients (85%) had no complaints at late follow up, and only 3 reported either no improvemen t or recurrence: 10 reported slight soiling, and only one patient rema ined incontinent. Conclusion: Sphincterotomy is the operation of choic e for patients with anal fissures that have not responded to conservat ive treatment, particularly as it can be done effectively and safely i n the outpatient clinic under local anesthesia.