What question did this study set out to answer?

This study aims to evaluate and compare the outcomes of two surgical techniques for treating chronic anal fissures.

March 1, 20260 citationsOpen Access

Battle of the Blades: Transmucosal Versus Lateral Anal Sphincterotomy- A Case Series

Key Points

This study aims to evaluate and compare the outcomes of two surgical techniques for treating chronic anal fissures.
Conducted as a case series with eight patients not responding to medical treatment.
Divided patients into two groups of four for each surgical technique.
Performed postoperative assessments for pain relief, fissure healing, and complications.
Significant pain relief reported in both surgical groups after the procedure.
Most patients experienced complete fissure healing in both treatment modalities.
No major complications or recurrences were noted during the follow-up period.

Abstract

Background: Fissure in ano is an ulcer in the longitudinal axis of the lower anal canal. Globally, the Annual incidence is estimated between 0.1–0.2% (≈ 1–2 cases per 1,000 people per year)Affects both sexes equally, most common in young and middle-aged adults. Commonly it occurs in the midline, posteriorly (more common in males), but can also occur in the midline anteriorly (more common in females). 95% of anal fissures in men are posterior; 5% are anterior. 85% of anal fissures in females are posterior; 20% are anterior. Failure of conservative and medical therapy necessitates surgical intervention. Lateral Anal sphincterotomy (LAS) is the established gold-standard procedure, while Transmucosal internal anal sphincterotomy (TMIS) has emerged as a newer technique aimed at achieving similar outcomes with minimal tissue dissection. Objective: To evaluate and compare the outcomes of transmucosal internal anal sphincterotomy and lateral anal sphincterotomy in the treatment of chronic fissure in ano. Methods: This study was conducted as a case series including eight patients with chronic fissure in ano who did not respond to medical management divided four each for the two treatment modalities. Four patients underwent transmucosal internal anal sphincterotomy, and four patients underwent lateral anal sphincterotomy. Patients were followed postoperatively to assess pain relief, fissure healing, and complications. Results: All patients in both groups showed significant relief from pain in the early postoperative period. Complete fissure healing was achieved in the majority of cases in both transmucosal internal anal sphincterotomy and lateral anal sphincterotomy groups. No major complications were observed. No recurrence was observed during the study period. Conclusion: Transmucosal internal anal sphincterotomy and lateral anal sphincterotomy demonstrated equivalent efficacy in chronic anal fissure healing, with comparable pain relief, complication rates, and satisfaction at short-term follow-up. Transmucosal internal anal sphincterotomy may be considered an alternative surgical option, especially for surgeons seeking a less invasive dissection., Further large-scale multicenter trials are needed to confirm long-term outcomes.

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