Original article Results following conservative lateral sphincteromy for the treatment of chronic anal fissures G. Garcea, C. Sutton, S. Mansoori, T. Lloyd and M. Thomas Ward 12, Leicester General Hospital, Leicester, UK Received 19 September 2002; accepted 2 December 2002 Abstract Introduction Lateral sphincterotomy is now the stand- ard surgical treatment for fissure-in-ano. Healing is achieved in 90% of cases, however, sphincterotomy also carries a significant risk of incontinence. Traditional sphincterotomy comprises of division of the internal sphincter up to the level of the dentate line, a more conservative division could lead to a lower incontinence rate, with an equivalent healing rate. Materials and methods A total of 65 patients under- going conservative lateral sphincterotomy under a single operator between January 1996 and January 2002 were reviewed. Specific questions were asked regarding overall success of the operation, leakage of fluid, faeces or flatus and recurrence of fissure symptoms. Supplemental data was obtained from a retrospective analysis of the patients’ case notes to ascertain demographics, length of hospital stay and complication rate. Results Sixty of 65 patients responded to our postal questionnaire. The male to female ratio was 1 : 1 and the mean age 40.3 years of age. No complications were recorded and 97% of patients had achieved fissure healing by the time of their out-patient follow-up (mean 6.9 weeks). Two patients reported new incontinence following their procedure; one patient experienced incontinence of fluid and flatus (1.7%) and the remaining patient complained of incontinence to flatus only. No patients experienced incontinence of faeces. Eleven patients experienced persistent symptoms of pain and bleeding but only 6 of these patients required treatment from their general practitioner which consisted of stool softeners and topical analgesia. No patients required re-operation. Conclusion A conservative division of the internal anal sphincter results in adequate fissure healing and a much lower incontinence rate than that previously recorded in the literature for more traditional divisions of the internal anal sphincter. Keywords Anal fissure, lateral sphincterotomy, surgical treatment, chronic Introduction An anal fissure is a linear tear in the lining of the distal anal canal. It is a common condition with an equal male to female incidence and is found more often in younger patients [1]. Accepted practice for chronic anal fissures and, more recently, for those resistant to GTN paste, is a controlled surgical division of the internal anal sphincter fibres – the sphincterotomy. The major complication of this proce- dure is disturbance of sphincter function leading to incontinence. In 1951 Eisenhammer’s first description of sphincterotomy recommended four-fifths to total divi- sion of internal anal sphincter [2], which was later amended 8 years later to division up to the level of the dentate line [2]. Since then, sphincterotomy has been traditionally performed up to or just above the level of the dentate line [3–5]. We have looked at a more conservative division of the internal anal sphincter to see if adequate healing of anal fissures can be achieved but with a lower incontinence rate by preserving more sphincter function. Materials and methods Sixty-five consecutive patients who underwent a lateral internal sphincterotomy at the Leicester General Hospital were identified using computerized medical coding records. All the procedures were performed by a single consultant from January 1996 and January 2002 were Correspondence to: Giuseppe Garcea, Ward 12, Hepatobiliary Research Office, The Leicester General Hospital, Gwendolen Road, Leicester, LE1 6PY, UK. E-mail: gg43@le.ac.uk Ó 2003 Blackwell Publishing Ltd. Colorectal Disease, 5, 311–314 311