What is the surgery of choice for chronic anal fissures?

Updated: Nov 09, 2018
  • Author: Bruce M Lo, MD, MBA, CPE, RDMS, FACEP, FAAEM, FACHE; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Answer

LIS is considered the treatment of choice for chronic anal fissure and can be performed either opened or closed. [17, 39, 40] It reduces the hypertonia of the internal anal sphincter, increases anodermal blood flow, decreases pain, and allows the fissure to heal. However, traditional LIS has been associated with relatively high rates of incontinence.

A systematic review and meta-analysis of the literature (inception to January 2017) that compared the efficacy of LIS with that of anal advancement flap (AAF) in 4 trials involving 300 patients found a significantly lower rate of anal incontinence than that of LIS, but wound complications and rate of unhealed fissures were comparable. [41]


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