title: Randomized clinical trial of transcutaneous electrical posterior tibial nerve stimulation versus lateral internal sphincterotomy for treatment of chronic anal fissure.
abstract: OBJECTIVE
  The objective of this study was to evaluate the efficacy of transcutaneous electrical posterior tibial nerve stimulation in treatment of patients with chronic anal fissure and to compare it with the conventional lateral internal sphincterotomy.
  
  
  METHODS
  Consecutive patients with chronic anal fissure were randomly allocated into two treatment groups: transcutaneous electrical posterior tibial nerve stimulation group and lateral internal sphincterotomy group. The primary outcome measures were number of patients with clinical improvement and healed fissure. Secondary outcome measures were complications, VAS pain scores, Wexner's constipation and Peascatori anal incontinence scores, anorectal manometry, and quality of life index.
  
  
  RESULTS
  Seventy-three patients were randomized into two groups of 36 patients who were subjected to transcutaneous electrical nerve stimulation and 37 patients who underwent lateral internal sphincterotomy. All (100%) patients in lateral internal sphincterotomy group had clinical improvement at one month following the procedure in contrast to 27 (75%) patients in transcutaneous electrical nerve stimulation group. Recurrence of anal fissure after one year was reported in one (2.7%) and 11 (40.7%) patients in lateral internal sphincterotomy and transcutaneous electrical nerve stimulation groups respectively. Resting anal pressure and functional anal canal length were significantly reduced after lateral internal sphincterotomy.
  
  
  CONCLUSIONS
  Transcutaneous electrical posterior tibial nerve stimulation for treatment of chronic anal fissure is a novel, non-invasive procedure and has no complications. However, given the higher rate of clinical improvement and fissure healing and the lower rate of fissure recurrence, lateral internal sphincterotomy remains the gold standard for treating chronic anal fissure.
authors: General and Endocrine Surgery, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt. Electronic address: tamyousif@yahoo.com.
authors: Tamer
authors: T
authors: Youssef
authors: General and Colorectal Surgery, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt.
authors: Mohamed
authors: M
authors: Youssef
authors: General and Colorectal Surgery, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt.
authors: Waleed
authors: W
authors: Thabet
authors: General and Endocrine Surgery, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt.
authors: Ahmed
authors: A
authors: Lotfy
authors: Rheumatology and Rehabilitation, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt.
authors: Reham
authors: R
authors: Shaat
authors: Rheumatology and Rehabilitation, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt.
authors: Eman
authors: E
authors: Abd-Elrazek
authors: General and Colorectal Surgery, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt.
authors: Mohamed
authors: M
authors: Farid
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000503:physiopathology / Q000601:surgery; D002908:Chronic Disease; D003248:Constipation / Q000209:etiology; D013505:Digestive System Surgical Procedures / Q000379:methods; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D005401:Fissure in Ano / Q000150:complications / Q000601:surgery / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011312:Pressure; D011446:Prospective Studies; D011788:Quality of Life; D012008:Recurrence; D013979:Tibial Nerve; D004561:Transcutaneous Electric Nerve Stimulation / Q000379:methods; D016896:Treatment Outcome; D014945:Wound Healing; D055815:Young Adult
keywords: Chronic anal fissure; Lateral internal sphincterotomy; Sacral nerve stimulation; Transcutaneous electrical nerve stimulation