A CRITICAL-APPRAISAL OF PATHOGENESIS AND MORBIDITY OF SURGICAL-TREATMENT OF CHRONIC ANAL-FISSURE

Preoperative and postoperative manometric findings and the results of lateral internal sphincterotomy were analyzed in 44 consecutive patien ts affected with chronic anal fissure. Preoperatively, resting anal pr essure was increased in 32 patients. At one month postoperatively, 23 patients showed normal pressures, whereas 14 were still hypertonic and seven, hypotonic. Only three patients still had a weak sphincter six months postoperatively, The overall morbidity rate was 31.8 percent. M inor complications occurred in 11 patients. Major complications affect ed three patients. Overall, impaired continence was recorded in eight patients, although only two complained of persistent, albeit lesser, d efects of continence not requiring the use of pads. Nonoperative treat ment should be reserved for few selected patients with recent, acute f issures. As for chronic anal fissures, compared with other operative o r nonoperative modalities of treatment, lateral internal sphincterotom y is a highly successful procedure and its minimal morbidity is well a ccepted by the patient.