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Evidence summaries

Operative Procedures for Fissure in Ano

Open and closed partial lateral sphincterectomy are effective procedures for anal fissure. Anal stretch and posterior midline internal sphincterectomy are less effective or have more complications. Level of evidence: "A"

A Cochrane review [Abstract] 1 included 24 studies with a total of 3475 subjects. Anal stretch has a higher risk of fissure persistence than internal sphincterectomy (OR 1.55, 95% CI 0.85 to 2.86; 7 studies, n= 493) and also a higher risk of minor incontinence than sphincterectomy (OR 4.03, 95% CI 2.04 to 7.96; 7 studies, n=493). After exclusion of two studies causing heterogeneity, the overall effect for efficacy favoured sphincterectomy (OR 3.35, 95% CI 1.55 to 7.26). Open and closed partial lateral internal sphincterectomy show little difference both in fissure persistence and risk of incontinence.

Author's comment: Anal stretch and posterior midline internal sphincterotomy should probably be abandoned in the treatment of chronic anal fissure in adults.

References

  • Nelson RL. Operative procedures for fissure in ano. Cochrane Database Syst Rev 2010;(1):CD002199. [PubMed]

Primary/Secondary Keywords