640 © 2019 Annals of Medical and Health Sciences Research Original Article Research Article How to Cite this Article: Ismaeil DA, et al. Comparison between Open Lateral Sphincterotomy and Posterior Midline Sphincterotomy with Fissurectomy in Treatment of Chronic Anal Fissure. Ann Med Health Sci Res; 9: 640-643 This is an open access article distributed under the terms of the Creative Com‑ mons Attribution‑NonCommercial‑ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non‑commercially, as long as the author is credited and the new creations are licensed under the identical terms. Introduction Anal fssure (AF) is a linear tear in the anoderm between the dentate line and the anal verge. [1,2] These fssures mainly are primary, where there is no exact pathogenesis of the condition, although trauma from the passing of a hard stool and hypertonicity of the internal anal sphincter (IAS) seems to be a main factor. [3] AF is a common condition, mainly presents with anal pain ± slight bright red bleeding with defecation. [1,4] Acute AF is determined when the fssure is presented for a period less than 8 weeks, and there is only a simple laceration, whereas a chronic AF has longer duration and associated with one or more signs of chronicity; a hypertrophied anal papilla at the proximal aspect of the fssure, a sentinel tag at the distal aspect of the fssure, and exposed IAS muscle fbers at the base of the fssure. [1,5,6] AF is mostly located at posterior midline (90%), although it may be located at anterior midline, which is mainly found in females (25%), and (8%) in males. In (3%) of patients fssures can be located at posterior and anterior positions simultaneously. Fissures that located rather than the midline is considered to be atypical or secondary and needs more evaluation, because of possibility of association with serious diseases, like Crohn’s disease and immunodefciency syndromes. [1,6] Internal anal sphincterotomy at the lateral position is known to be superior to anal dilatation, and can be performed by both open or closed techniques, which nearly equal effectiveness. [7] Posterior internal Sphincterotomy (PIS) was considered by Comparison between Open Lateral Sphincterotomy and Posterior Midline Sphincterotomy with Fissurectomy in Treatment of Chronic Anal Fissure Deari A. Ismaeil 1 , Kamil Haydar 2 , Ary Hama Saeed 3 and Alaa Sabeeh 4 1 Department of Surgery, Medical College, University of Sulaimani, Kurdistan Region, Iraq; 2 Department of Surgery, Ranya Teaching Hospital, Kurdistan Region, Iraq; 3 Department of Surgery, Sulaimani Teaching Hospital, Kurdistan Region, Iraq; 4 Department of Community Medicine, Medical College, University of Sulaimani, Kurdistan Region, Iraq Abstract Background: Anal fssure is a common condition. Lateral internal sphincterotomy is recommended as the standard procedure for treating chronic anal fssure. Fissure healing can also be achieved by a posterior midline sphincterotomy, which may be associated with prolonged healing, as well as passive anal leakage. Objectives: This is to compare the efectiveness and outcome between two methods of treating chronic anal fssure; open lateral internal sphincterotomy with fssurectomy versus posterior midline sphincterotomy with fssurectomy, in terms of post-operative complications; pain, infection, bleeding, bruising, abscess, fstula and incontinence. Patients and methods: A Retrospective study including 100 patients presented with chronic anal fssure. The patients were distributed between two equal groups: group-A underwent open lateral sphincterotomy, and group-B underwent posterior midline sphincterotomy. Both groups were evaluated for postoperative complications. The patients were followed after the surgery at least for 9 months, up to 41 months, with mean of (27.69±7.31) months. Results: From these 100 patients, 83 were females and 17 were males. The mean age was (33.17±7.06) years. The main symptom was pain, then bleeding and constipation. Most of the fssures were located at 6 o’clock. Postoperative complications found in 27 patients: infections found more in group-B, while bleeding, bruising and incontinence were more in group-A. There was no postoperative abscess or fstula formation, and no recurrence detected. Conclusion: We found no diferences in surgical treatment for the chronic anal fssure, between open lateral sphincterotomy and posterior midline sphincterotomy in term of symptomatic pain relief, healing rates and the side efect occurrence after operations. Keywords: Chronic anal fssure; Lateral internal sphincterotomy; Posterior internal sphincterotomy with Fissurectomy Corresponding author: Deari A. Ismaei, Department of Surgery, Medical College, University of Sulaimani, Kurdistan Region, Iraq. Tel: 918067549920; Email: azad_abdulahi@yahoo.com