Outcomes of Closed Versus Open Lateral Internal Anal Sphincterotomy for Chronic Anal Fissure: A Randomized Controlled Trial
DOI:
https://doi.org/10.37018/XCVB0327Keywords:
Chronic Anal Fissure, Lateral Internal anal Sphincterotomy, Closed Technique, Open Technique, Wound Healing, Randomized Controlled TrialAbstract
Background: Lateral internal anal sphincterotomy (LIAS) is the treatment of choice for chronic anal fissure (CAF) when conservative management fails to heal the fissure. While both closed and open techniques are widely used, comparative data on wound healing outcomes and predictors of healing remain limited. This randomized controlled trial compared closed versus open LIAS under different anesthesia protocols and identified independent predictors of wound healing.
Methodology: In this trial 160 patients suffering from chronic anal fissure were randomly allocated to undergo either closed LIS under local anesthesia with sedation or open LIS under spinal anesthesia. The primary outcome was complete wound healing at 6 weeks. Secondary outcomes included pain at 24 hours, return to work, anal incontinence at 6 weeks and 1 year, and recurrence at 1 year. Multivariate logistic regression was computed to identify in-dependent predictors of non-healing.
Results: Baseline characteristics were comparable between groups. Closed LIAS was associated with significantly lower pain scores at 24 hours (1.1 ± 0.3 vs 3.3 ± 0.6, p < 0.001) and faster return to work (3.3 ± 1.1 vs 6.6 ± 1.4 days, p < 0.001). Healing rates at 6 weeks were excellent and comparable between the two groups (96.3% vs 97.5%, p = 0.62). Transient flatus incontinence occurred in 2.5% of closed LIAS and 5.0% of open LIAS patients (p = 0.41), with no cases of fecal incontinence. Recurrence at one year was 4.0% in the closed group and 3.0% in the open group (p = 0.58). On multivariate analysis, independent predictors of non-healing were age ≥ 40 years and fissure duration > 12 months.
Conclusion: Both closed and open lateral internal anal sphincterotomy are highly effective treatments for chronic anal fissure, achieving excellent healing rates with no permanent incontinence. Closed LIAS under local anesthesia with sedation offers superior early outcomes with less pain, faster return to work, and the advantage of same-day discharge.
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Copyright (c) 2026 Ejaz ul Hassan, Ayesha Choudary, Hina Khan, Shabbar Hussain Changazi, Samiullah Bhatti, Qamar Ashfaq Ahmad
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