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Posterolateral versus lateral internal anal sphincterotomy in the treatment of chronic anal fissure: a randomized controlled trial

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Background

Lateral internal anal sphincterotomy (LIS) is considered the treatment of choice for chronic anal fissure. This study aimed to compare the outcome of standard LIS and posterolateral internal sphincterotomy (PLIS) at 5 o’clock position as regards healing of anal fissure, improvement in symptoms, and complications.

Methods

Patients with chronic anal fissure were randomly allocated to one of two groups; group I underwent PLIS and group II underwent LIS. Patients were compared regarding the duration of healing of anal fissure, improvement in anal pain as recorded by visual analogue scale (VAS), complications, particularly fecal incontinence (FI) and changes in the anal pressures.

Results

Eighty (49 females) patients were included to this trial. The mean age of patients was 35.5 years. The duration of healing was significantly shorter in group I than in group II (4.1 ± 1.7 vs 5.8 ± 1.4 weeks; p < 0.0001). Group I achieved significantly lower pain score at 1 month postoperatively than group II (1.1 ± 0.9 vs 1.7 ± 0.98; p = 0.005). Two (2.5%) of group I patients and six (10%) of group II patients experienced minor FI postoperatively. The postoperative reduction in the mean resting anal pressure in group I was significantly higher than that in group II.

Conclusion

Time to complete healing was significantly shorter and pain score was significantly lower after PLIS than after LIS which can be due to more reduction in the resting anal pressure after PLIS. Continence disturbances occurred after PLIS less frequently than after LIS; however, no significant differences between the two techniques were noted.

Trial registration

www.clinicaltrials.gov NCT03426449

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Author information

Authors and Affiliations

  1. General Surgery Department, Faculty of Medicine, Mansoura University Hospitals, Elgomhuoria Street, Mansoura City, Egypt

    Mohammed Alawady, Mahmoud Abdelnaby & Hosam Elbanna

  2. Colorectal Surgery Unit, General Surgery Department, Mansoura Faculty of Medicine, Mansoura City, Egypt

    Sameh Hany Emile & Mohamed Farid

Authors
  1. Mohammed Alawady
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  2. Sameh Hany Emile
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  3. Mahmoud Abdelnaby
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  4. Hosam Elbanna
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  5. Mohamed Farid
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Contributions

Mohamed Farid introduced the concept of and designed the study. Sameh Emile and Mohammed Alawady collected the required data. Mohammed Alawady, Sameh Emile, Mahmoud Abdelnaby, and Hosam Elbanna conducted the procedures and the analysis of data. Mohamed Farid conducted interpretation of the results. Sameh Emile, Mohammed Alawady, and Hosam Elbanna wrote the manuscript. Mohamed Farid, Mahmoud Abdelnaby, and Hosam Elbanna drafted and critically revised the manuscript.

Corresponding author

Correspondence to Mohammed Alawady.

Ethics declarations

Ethical approval for the study was obtained from the institutional review board (IRB) of Mansoura Faculty of Medicine.

Conflict of interest

The authors declare that they have no conflict of interest.

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Alawady, M., Emile, S.H., Abdelnaby, M. et al. Posterolateral versus lateral internal anal sphincterotomy in the treatment of chronic anal fissure: a randomized controlled trial. Int J Colorectal Dis 33, 1461–1467 (2018). https://doi.org/10.1007/s00384-018-3087-6

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  • DOI: https://doi.org/10.1007/s00384-018-3087-6

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