Fissurectomy for Treatment of Chronic Anal Fissures

Excerpt

To the Editor—The paper by Pelta et al. 1 reflects the outcome of several debates about the surgical treatment option for anal fissures. Although controversially discussed, lateral sphincterotomy is associated with a higher incidence of fecal incontinence (30–45 percent),2,3 depending on preceding obstetric trauma and proctologic operations and, therefore, has been abandoned in many European centers or described as an overtreatment. Especially in older patients with weak internal anal sphincter muscle or even sphincter defects, lateral sphincterotomy might deteriorate sphincter function. Recurrence rates after lateral sphincterotomy are between 5 and 11 percent according to previously published data.4 Major concerns of recurrent anal fissures after lateral sphincterotomy are the residual hypertrophied anal papilla, the sentinel tag, and the underlying fistula tract, which remain untouched with this technique. Unfortunately, only a few authors confirmed the existence of subcutaneous fistula tracks (e.g., in 80 percent of the fissurectomy specimens5) corresponding to the “undrained smouldering infection” theory described in the paper by Pelta et al. 1 …