Comparıson of the result of fıssure apex lateral internal sphincterotomy to spasm controlled sphincterotomy in chronic anal fissures

SUMMARYThe aim of this study was to investigate and individualize the ideal level of lateralinternal sphincterotomy for chronic anal fissure and decrease the complications ofsurgery. Chronic anal fissure a common disorder, and it has traditionally been managedwith lateral internal sphincterotomy. The first sphincterotomy was performed in 1951first and it has evolved in time. The level of sphincterotomy is controversial. Surgicalsphincterotomy for chronic anal fissure can cause anal incontinence over one third ofthe patients. This has led to the investigation of sphincterotomy level that may avoidpermanent damage to the internal anal sphincter. There is evidence demonstrating thatthe incontinence rate is related to the extent of the lateral internal sphincterotomy. Moststudies have showed that the accurate sphincterotomy level is unknown. Nonsurgicaltreatment options such as chemical sphincterotomy (nitroglycerine or diltiazemointment and botulinum toxin injections, e.g.) can be a treatment option but they are notsuperior to surgery.In the present study, we suggest spasm-controlled LIS is a good choice todetermine anal stenosis and to navigate the extent of sphincterotomy for a given patient.Calibrator controlled sphincterotomy is more effective and secured. We found thathealing rates are significantly higher, recovery is earlier and complications are fewer inthe spasm-controled group, compared with the fissure apex sphincterotomy group.