A Prospective Randomized Controlled Trial Comparing Three Lateral Internal Sphincterotomy Techniques for Chronic Anal Fissure

What this Trial Is About

Researchers are evaluating three different surgical techniques of lateral internal sphincterotomy (LIS) for patients with chronic anal fissure that has not improved with medical treatment. The study aims to compare the healing rates and the occurrence of fecal incontinence among these techniques over 12 months. This trial is a prospective randomized controlled study involving 150 adult patients, assessing how different extents of sphincterotomy affect outcomes. The three techniques being compared are Spasm-Controlled LIS, which uses serial small sphincterotomies under local anesthesia and sedation until a target anal canal size is reached; LIS up to the Fissure Apex, an open procedure under spinal or general anesthesia extending to the fissure's end; and LIS up to the Dentate Line, the traditional open method extending to the dentate line, also under spinal or general anesthesia. Randomization assigns patients equally to one of these groups, and all surgeries are performed with an open technique in the lithotomy position. Participants will be evaluated before surgery and at several points after surgery including day 1, weeks 1 and 2, and months 1, 2, 6, and 12. Researchers will use the Wexner Incontinence Score to assess continence and will check for fissure healing, pain levels, recurrence, patient satisfaction, and complications. The study includes careful monitoring to compare the effectiveness and safety of the different surgical approaches over a full year.

Comparison of Lateral Internal Sphincterotomy Techniques for Chronic Anal Fissure