Long-term prospective randomised clinical and manometric comparison between surgical and chemical sphincterotomy for treatment of chronic anal fissure.

AIM To compare surgical and chemical sphincterotomy for treatment of chronic anal fissure. METHODS The 160 patients studied were randomly divided into four equal groups, treated by lateral internal sphincterotomy (group S), local diltiazem ointment (group D), local glyceryl trinitrate ointment (group GTN), or injection of botulinum toxin into the internal anal sphincter (group BT). Anal manometry was performed before and 3 months after treatment. Patients were followed up for 5 years. RESULTS Complete pain relief was achieved in means (+/- standard deviation) of 5.7+/-7.8 days (group S), 15.7+/-5.9 days (group D), 15.6+/-5.9 days (group GTN) and 2.7+/-3.6 days (group BT). The mean times to healing were 4.5+/-1.2 weeks (group 1), 5.1+/-1.1 weeks (group D), 5.0+/-1.1 weeks (group GTN) and 5.1+/-1.3 weeks (group BT). Mean resting and squeeze anal pressures decreased significantly after sphincterotomy. Recurrence rates were 10% in group S, 65% in group D, 57.5% in group GTN and 52.5% in group BT. CONCLUSION Lateral internal sphincterotomy is an easy procedure with satisfactory results, minimal complications and a low recurrence rate. Medical sphincterotomy is safe and easy, with mild complications. Its effect is reversible, and relapse is common. We recommend that medical sphincterotomy be tried before surgery or in patients who are unable or unwilling to undergo surgery.