Stretching of Anal Sphincters in Treatment of Fissure-in-Ano

Abstract

The technique and results of stretching the anal sphincters for fissure-in-ano have been reviewed in 99 patients, the mean length of follow-up being 21 months. The outcome is compared with that of internal sphincterotomy previously reported (Bennett and Goligher, 1962). The following conclusions are reached: (a) Sphincter-stretching almost invariably produces rapid relief from the pain of fissure-in-ano, but is followed by persistent or recurrent pain and/or fissure in about 16% of cases. In this respect it is inferior to internal sphincterotomy, which had a recurrence rate of 7%. However, recurrent symptoms are often mild, and further treatment was necessary in only slightly more than one-half of these patients. (b) It is an operation that can be performed with ease by relatively untrained staff, and the patient quickly returns to work with the minimum of post-operative care. (c) Minor defects of anal control occurred in only 28% of patients after sphincter-stretching, compared with 43% after internal sphincterotomy. (d) For patients requiring surgical treatment for fissure-in-ano for the first time, whatever the duration of symptoms, stretching of the anal sphincters is, in our opinion, the procedure of choice. It provides an excellent chance of relieving pain and a good chance of permanent cure with minimum inconvenience to the patient. However, if further operation should be required for recurrent symptoms we would recommend internal sphincterotomy, as, in our hands, repeated sphincter-stretching has been found to be ineffective. © 1964, British Medical Journal Publishing Group. All rights reserved.