Closed versus open lateral internal anal sphincterotomy for chronic anal fissure in female patients

Objective
The aim of the study was to determine the best technique for surgical treatment of chronic anal fissure in female patients.
Study designs
The study was designed as a prospective randomized study.
Place and duration of study
The study was conducted in Surgical Unit, Al Kuwait University Hospital and Al Huribi Hospital (Sana'a, Yemen) from January 2007 to December 2010.
Patients and methods
A total of 205 female patients undergoing surgery were divided into two groups. In group A, there were 100 patients who were treated by closed lateral internal anal sphincterotomy, and in group B there were 105 patients who were managed by open lateral internal anal sphincterotomy method. Patients were followed up for 6 months following surgery to observe for pain, bleeding, infection, incontinence, and recurrence.
Results
There was acceptable difference in postoperative acute complications between the two methods of internal anal sphincterotomy. However, in group A, six patients (6%) were complicated with very low anal fistula postoperatively, whereas the recurrence rate was 6 versus 1.9% in group A versus group B, respectively ( = 0.015).
Conclusion
Lateral internal sphincterotomy either with open or closed method is the treatment of choice for chronic anal fissure in female patients and can be performed effectively and safely with acceptable rate of complications; however, the open method is considered to have less morbidity and rate of recurrence.