LONG-TERM CLINICAL AND MANOMETRIC COMPARISON BETWEEN SURGICAL AND CHEMICAL SPHINCTEROTOMY FOR TREATMENT OF CHRONIC ANAL FISSURE

Aim: comparison between surgical and chemical sphincterotomy for treatment of chronic anal fissure. Methods: 160 patients were equally randomly divided into 4 groups treated by: lateral internal sphincterotomy (Group I), local Diltiazem ointment (Group II), local Glyceryl trinitrate ointment (Group III), or injection of Botulinum toxin into the internal anal sphincter (Group IV). Anal manometry was measured before and 3 months after treatment. Patients were followed up for 5 years. Results: Mean time for complete pain relief was 5.68±7.77 days (Group I), 15.7 ± 5.87 days (Group II), 15.6 ± 5.90 days (Group III) and 2.67 ± 3.60 days (Group IV). Mean healing time was 4.48±1.20 weeks (Group I), 5.12±1.13 weeks (Group II), 5.00±1.12 weeks (Group III) and 5.06±1.31 weeks (Group IV). Mean resting and squeeze anal pressures decreased significantly after sphincterotomy. Recurrence rate was 10% in Group I, 65% in Group II, 57.5% in Group III and 52.5% in Group IV. Conclusion: Lateral internal sphincterotomy is easy and satisfactory, with minimal complications and recurrence. Medical sphincterotomy is safe, and easy, with mild complications. Its effect is reversible. Relapse after it is common. It is worth trial before surgery or in patients that cannot or unwilling to undergo surgery