Anal fissure is a common and painful disorder. Its relation to hypertonic anal
sphincter is controversial. The most common surgical treatment of chronic anal
fissure is lateral internal sphincterotomy either open or closed methods,
associated with a risk of pain, bleeding, recurrence and incontinence.
The study was designed to compare the results of open and closed technique
of lateral internal sphincterotomy and to find postoperative complications.
This prospective clinical trial conducted in the Department of surgery in Basrah
General Hospital between January 2006 and October 2008, one-hundred
patients were randomly assigned to open or closed internal sphincterotomy.
Standardized questionnaires assessing patients were administered
preoperatively and at 1st, 2nd weeks and 1-6 month postoperatively.
Out of the 100 patients included in the study, 50 patients underwent open
lateral internal sphincterotomy and the other 50 were subjected to closed lateral
internal sphincterotomy. There was no significant difference in postoperative
acute complications. However, incontinence in terms of soiling and passage of
flatus was 14% in open method and 10% in closed method. There was no
difference in terms of recurrence rate being 4% both in open and closed
In conclusion, there was no significant difference between open and closed
methods of lateral internal sphincterotomy in regard recurrence rate, healing
rate, hospital stay and other complications, but in view of these findings, closed
method of treatment is recommended if the surgeon is experienced.