Comparative Study of Lateral Internal Sphincterotomy and Medical Management in Chronic Anal Fissure

Background: Chronic anal fissure is a common condition that affects the anorectal region and causes considerable pain and reduced quality of life for the patient. LIS surgery and medical therapy are standard treatments. The present study sought to assess the outcomes of LIS surgery and medical therapy among patients with chronic anal fissure. Methods: A Comparative observation study was carried out at the Department of General Surgery of a tertiary care hospital from March to August 2026. The total number of 260 patients having chronic anal fissure was selected and equally distributed in two groups (LIS = 130, Medical management = 130). The outcome measures include fissure healing, pain score, time required for fissure healing, recurrence, hospitalization period, resuming regular activities, need for further treatment, and patient satisfaction. Results: There was a high proportion of healing after 1 month with LIS compared to medical treatment (90.8% compared to 65.4%; p<0.001), and after 3 months 95.4% vs 77.7% (p<0.001). The mean healing time was shorter with LIS. There was a significant difference in pain scores at 1 week, 1 month, and 3 months with LIS (p<0.001). There was a low proportion of recurrence after 6 months with LIS (3.1%) compared to medical treatment (10.8%), (p=0.028). Conclusion: LIS was found to have better healing rate, more pain reduction, less recurrence and earlier recovery than the medical therapy. Treatment should be individualized depending on the clinical features and the patients’ preference.