Combined mucosal advancement and lateral internal sphincterotomy in treatment of chronic anal fissure: could be an effective alternative procedure?

Background: Chronic Anal Fissure (CAF) is a common anal problem. Lateral Internal Sphincterotomy (LIS) is the recommended treatment when conservative treatment fails, however it has its drawbacks. On the other hand, Anal Advancement Flap (AAF) may help in some cases. In this study, we tried to combine both techniques to evaluate the outcome of this dual procedure. Methods: This prospective study was conducted on one hundred patients with chronic anal fissure who were divided randomly into two groups group (A) LIS, group (B) the combined technique. Both groups were compared regarding, pain and constipation prior to treatment and at 1, 2, 4, 6 weeks post-operative using Visual Analogue Scale (VAS) and Wexner constipation score at 6weeks in addition to timing of complete fissure healing. Results: Both groups were comparable preoperatively regarding demographic data, pain score, constipation score but post-operative group B has achieved an earlier significant decrease in pain score, (1.7±0.65 vs 4.4±1.1) at 1 st week (P<0.001) and (1.5±0.55 vs 3.3±1.04) at 2 nd week also (P<0.001). In addition to a superior healing rate (96% vs 76%) at 4 th week (P=0.009) with non-significantly longer operative time or complication rate. Conclusions: The combined technique of mucosal advancement and LIS can achieve a superior outcome compared to the traditional LIS in the treatment of CAF regarding faster healing rates with marked decrease in early post- operative pain and by far earlier return to normal life habits.