title: Open versus closed lateral internal anal sphincterotomy in the management of chronic anal fissures: a prospective randomized study.
abstract: OBJECTIVE
  Chronic anal fissure is a benign disorder that is associated with considerable discomfort. Surgical treatment in the form of lateral sphincterotomy has long been regarded as the gold standard of treatment. This study compared the open and closed techniques of lateral sphincterotomy in terms of their postoperative outcomes.
  
  
  METHODS
  A prospective, randomized comparative study was conducted between October 2010 and August 2012. A total of 136 patients were randomly assigned to each of two groups. Patients were followed up postoperatively for more than 1 year to assess any complications. The outcomes were compared among the two groups using the Chi-square test and Student t test.
  
  
  RESULTS
  The mean age at presentation was 40.13 years. The male to female ratio was 1.47:1. The typical presentation was painful defecation. Fissures were most often located in the posterior midline and associated with a sentinel pile. Delayed postoperative healing was found in 4.4% of the group of patients undergoing open lateral sphincterotomy. The mean pain score and duration of hospital stay were lower with the closed technique.
  
  
  CONCLUSIONS
  Closed lateral internal sphincterotomy is the treatment of choice for chronic fissures as it is effective, safe, less expensive, and associated with a lower rate of complications than the open sphincterotomy technique.
authors.affiliation: Department of General Surgery, Kasturba Medical College, Manipal University, Manipal, India.
authors.forename: Vivek
authors.initials: V
authors.lastname: Gupta
authors.affiliation: Department of General Surgery, Kasturba Medical College, Manipal University, Manipal, India. Electronic address: gabyrodricks@gmail.com.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Rodrigues
authors.affiliation: Department of General Surgery, Kasturba Medical College, Manipal University, Manipal, India.
authors.forename: Raghunath
authors.initials: R
authors.lastname: Prabhu
authors.affiliation: Department of General Surgery, Kasturba Medical College, Manipal University, Manipal, India.
authors.forename: Chandni
authors.initials: C
authors.lastname: Ravi
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000601:surgery*; D002908:Chronic Disease; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D005401:Fissure in Ano / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016037:Single-Blind Method
keywords: anal bleeding; chronic anal fissures; lateral sphincterotomy; pain