OUTPATIENT SURGICAL-TREATMENT OF ANAL-FISSURE

Objectives: To review our experience of treating anal fissures by lateral subcutaneous anal sphincterotomy in the outpatient clinic. Design: Retrospective study. Setting: University hospital, Israel. Subjects: 108 of 112 Consecutive patients with anal fissures. Interventions: All patients had failed to respond to a two week course of conservative treatment. They all underwent lateral subcutaneous anal sphincterotomy under local anaesthesia in either the outpatient clinic or the day-case operating theatre. Main outcome measures: Early and late morbidity, patient satisfaction, admission to hospital, and recurrence. Results: 108 of the 112 were followed up for a mean of 20 months (range 2-56). 100 (93%) reported that the late results were good to excellent. Four patients bled immediately after the operation and required admission to hospital and four developed abscesses of which only one responded to conservative treatment: 14 patients complained of initial mild incontinence but in most this resolved over time: 92, patients (85%) had no complaints at late follow up, and only 3 reported either no improvement or recurrence: 10 reported slight soiling, and only one patient remained incontinent. Conclusion: Sphincterotomy is the operation of choice for patients with anal fissures that have not responded to conservative treatment, particularly as it can be done effectively and safely in the outpatient clinic under local anesthesia.