OPEN LATERAL INTERNAL SPHINCTEROTOMY VERSUS CLOSED LATERAL INTERNAL SPHINCTEROTOMY IN THE TREATMENT OF FISSURE IN ANO: COMPARATIVE STUDY

Background: An anal fissure is a painful condition that affects the sensitive squamous epithelium in the lower half of the anal canal. Lateral internal sphincterotomy is still the primary treatment option. There are two techniques used: closed and open methods. The closed lateral internal sphincterotomy technique offers faster healing and fewer postoperative complications, while the open lateral internal sphincterotomy technique allows for direct visualization and controlled release of internal fibers. Objectives: To compare the results of open and closed lateral internal sphincterotomy techniques for treating anal fissures. Methods: This is a single‑blind randomized controlled study conducted at Mosul General Hospital and Shingal (Sinjar) General Hospital From the 1st of February 2019 to the end of May 2020. Patients aged more than 18 years who fit for anesthesia and they were suffered from difficult defecation, blood in stool, and a fissure in ano on clinical examination were enrolled. Patients with Crohn's disease, hidradenitis suppurativa, or sexually transmitted diseases were excluded. The questionnaire consisted from three parts. Part one for sociodemographic information, part two for patients past medical history, part three for preoperative and postoperative pain scores, bleeding per rectum and healing. Results: The study includes 60 patients with chronic anal fissure. The mean age ± standard deviation of the study participants was 43.11 ± 16.09 years. Of them, 36 (60%) patients were males and 24 (40%) were females, with male to female ratio of 1.5:1. No statistically significant difference between patients underwent open and closed lateral internal sphincterotomy regarding their age, gender and anal fissure location. Moreover, no statistically significant difference between the two groups regarding their past medical history. Furthermore, no statistically significant difference between the two groups regarding their preoperative and postoperative pain, bleeding per rectum and healing. Conclusion: Closed lateral internal sphincterotomy and open lateral internal sphincterotomy had similar fissure healing rates, with no significant difference in postoperative pain or per rectal bleeding. As a result, there is no significant difference in surgical outcomes between them in the treatment of fissures in ano.