Background and aims: Initial experience with the posterior sphincterotomy for treating anal fissures was unsatisfactory, with a significant rate of recurrences and anal incontinence. This report describes the lateral approach to complete section of the internal sphincter.
Patients and methods: Between 1997 and 2001 we surgically treated 164 patients for anal fissure. Preoperative and postoperative anal manometries were recorded. Postoperative course and early and long-term results were recorded.
Results: No fissure failed to heal. Early complications included bleeding, hematoma, and pain. A transient, variable degree of incontinence occurred in 15 patients and persistent incontinence to flatus and soiling in 5. After total sphincterotomy no long-term complication was observed. Patient satisfaction was 96%.
Conclusion: Total subcutaneous, internal sphincterotomy is a safe, effective procedure for the treatment of chronic anal fissure.