CHRONIC ANAL FISSURE A COMPARATIVE STUDY OF THREE DIFFERENT FORMS OF SURGERY

One hundred and twenty patients with fissure in ano were treated by different forms of surgery. Forty patients were
subjected to fissurectomy and posterior median sphincterotomy, forty were treated by lateral subcutaneous sphincterotomy and forty were treated by simple anal stretch. Lateral subcutaneous internal sphincterotomy proved to be the treatment of choice for chronic anal fissure. It is a simple procedure, avoids an open wound in the anal canal, followed by rapid healing of the fissure and has no recurrence. Anal stretch similar to sphincterotomy breaks the pathologically raised sphincter tone.
Most of the anal stretched patients were free of symptoms only few of them had to be treated again for the same disease by lateral sphincterotomy. It is an efficient out- patient procedure with immediate relief of pain, immediate return to work and rapid healing of the fissure. Fissurectomy with posterior median sphincterotomy results in delayed pain relief, delayed healing of the anal wound, prolonged period off-work and associated with high incidence of post operative complications mainly incontinence.