Fissurectomy as a treatment for anal fissures in children.
BACKGROUND
Anal fissures, characterised by painful defecation and rectal bleeding, are common in both children and infants. A significant proportion are resistant to simple laxative therapy, and no simple surgical treatment has been described which does not risk compromising sphincteric function. This study reports the initial experience of fissurectomy as a treatment of this condition.


METHODS
Over a 36 month period, 37 children with an anal fissure were treated by fissurectomy. There were 14 boys and 23 girls, with an age range of 17 weeks to 12 years. Fissurectomy was performed under general anaesthetic, with additional caudal anaesthesia. Stay sutures were used to avoid the need for an anal retractor, thereby preventing stretching of the internal anal sphincter. Of the 37 operations, 36 (97%) were performed as day cases and all children were discharged on laxative therapy.


RESULTS
At review, 6 weeks postoperatively, 30 (81%) were asymptomatic. Six (16%) patients were symptomatic; however, 4 of these had failed to comply with the postoperative laxative regimen. One patient failed follow-up.


CONCLUSIONS
Fissurectomy is a successful treatment for anal fissures, when combined with postoperative laxative therapy. As dilatation of the internal anal sphincter is not involved, the risk of iatrogenic faecal incontinence is obviated.
Department of Paediatric Surgery, Alder Hey Children's Hospital, Liverpool, UK.
G F
GF
Lambe
C P
CP
Driver
S
S
Morton
R R
RR
Turnock
D000763:Anesthesia, Caudal; D000768:Anesthesia, General; D002400:Cathartics / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003248:Constipation / Q000517:prevention & control; D013505:Digestive System Surgical Procedures / Q000379:methods; D005260:Female; D005401:Fissure in Ano / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D011182:Postoperative Care / Q000379:methods; D013536:Suture Techniques
D002400:Cathartics