A Comparative Study of Conservative, Medical, Lord's Anal Dilatation, Lateral Sphincterotomy, Posterior Sphincterotomy, Modified Anorectal Myomectomy and Transanal Endosurgical Procedures in the Treatment of Chronic Anal Fissure: A Retrospective Coho

Abstract Objective: To compare the effectiveness and safety of conservative/medical therapy, Lord’s anal dilatation, lateral internal sphincterotomy, posterior sphincterotomy (including modifications), anorectal myomectomy, and early transanal endosurgical procedures in the management of chronic anal fissure. Design: Retrospective cohort study. Setting: Shri M. P. Shah Medical College and the Irwin Group of Tertiary University Teaching Hospitals, Jamnagar, Gujarat, India (June 1980–May 1992). Participants: 280 consecutive adults with chronic fissure‑in‑ano allocated to conservative therapy (n=70), anal dilatation (n=70), lateral sphincterotomy (n=70), or posterior sphincterotomy with modifications (n=70). Subsets underwent modified anorectal myomectomy or early transanal endosurgical procedures. Interventions: Conservative therapy, Lord’s anal dilatation, lateral internal sphincterotomy, posterior sphincterotomy, modified anorectal myomectomy, and transanal endosurgical procedures including fissurectomy/sphincterotomy. Primary Outcomes: Pain relief, fissure healing at 6–8 weeks, and recurrence (6–24 months). Secondary Outcomes: Functional outcomes, complications, and re‑intervention. Results: Healing was highest after lateral sphincterotomy (94.3%) and posterior sphincterotomy (90.0%) compared with conservative therapy (62.9%) and anal dilatation (65.7%) (P<0.001). Recurrence was lowest after lateral sphincterotomy (4.3%) and highest after conservative therapy (25.7%) (P<0.001). Conservative therapy provided rapid pain relief but had the highest re‑intervention rate (28.6%). Functional outcomes were most favourable after posterior and lateral sphincterotomy (P=0.002). Conclusions: Lateral internal sphincterotomy demonstrated the most effective and durable outcomes for chronic anal fissure, with superior healing, lower recurrence, and better functional results. Conservative therapy offers early symptomatic relief but high recurrence. Findings support lateral sphincterotomy as the preferred surgical intervention.