Open vs. Closed Sphincterotomy for Surgical Treatment of Anal Fissures
Hisham Abdullah Almottowa *
Department of General Surgery, King Fahad General Hospital, Jeddah, Saudi Arabia.
Hassan Hamdan Almohammadi
College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
Hamzah Abdulaziz Alwehaimed
Department of Emergency Medicine, King Fahad Hospital, Hofuf, Saudi Arabia.
Osamah Salem Alsawat
College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
Abdullah Sulaiman Alboseer
Department of Emergency Medicine, King Fahad Sepcialist Hospital, Buraidah, Saudi Arabia.
Mohammad Younes Alshammari
College of Medicine, Arabian Gulf University, Manama, Bahrain.
Abdulrahman Ibrahim Alsheikh
College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Rami Jaber Alzaidi
Department of General Surgery, King Fahad General Hospital, Jeddah, Saudi Arabia.
Abdulaziz Usamah Alseffay
College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Jasem Mohammad Ameen
College of Medicine, Arabian Gulf University, Manama, Bahrain.
Noora Ziyad Alsaadoon
College of Medicine, Almaarefa University, Riyadh, Saudi Arabia.
*Author to whom correspondence should be addressed.
Abstract
There is currently no specific evidence regarding the exact etiology of anal fissures. However, various management options were reported and validated among the relevant research. Lateral internal sphincterotomy has been validated among relevant investigations in the literature as a valid modality for managing patients with chronic anal fissures. In the present literature review, we formulated evidence based on these studies to compare open and closed techniques of this surgery according to the reported outcomes. However, evidence regarding the superiority of either of the techniques over the other is not consistent among these investigations. For instance, some studies reported that closed sphincterotomy is more favorable than the open approach and should be considered the treatment choice for chronic anal fissures. This is because the technique is associated with less frequent rates of complications, less expensive, safe, and effective. On the other hand, many other relevant studies also demonstrated that the reported outcomes for the two modalities exhibited non-significant differences. Therefore, we suggest that researchers should furtherly conduct additional investigations before drawing any conclusions in this field.
Keywords: Lateral internal sphincterotomy, management, anal fissures, surgery