• Muhammad Zubair
  • Muhammad Saaiq
  • Syed Aslam Shah


Background: This study was undertaken to determine the efficacy and safety of subcutaneous lateral internal sphincterotomy (SLIS) for chronic anal fissure by assessing the relief of defecatory pain, duration of wound healing and associated complications such as bleeding, infection, and anal incontinence. Methods: This descriptive case series was carried out at the Department of Surgery, Pakistan Institute of Medical Sciences (PIMS), Islamabad from September 1, 2008 to February 28, 2009. Results: Out of fifty patients 31 were males and 19 were females. The mean age was 30.04±8.49 years. Defecatory pain and bleeding per rectum were the commonest symptoms, found among all patients. Symptomatic relief of pain following surgery was observed among all patients at 4th week while all fissures healed at 8th week. At 4th weeks follow-up visit none of the patients had flatus incontinence while at 8th weeks all patients had good faecal continence. Majority (76%) of the patients were managed as Day case or Extended day case surgeries. There was no in-hospital mortality in this case series. Conclusion: SLIS is a valuable surgical procedure for patients with chronic anal fissure. It is effective and safe, offers quick relief of defecatory pain, and promotes early fissure healing without being attended by any major complications. The initial transient incontinence of flatus and faeces improves spontaneously over few weeks period. Majority of the patients are manageable on day case or extended day case surgery basis.Keywords: Chronic anal fissure. Subcutaneous lateral internal sphincterotomy, Day case surgery


Lunniss PJ. The anus and anal canal. In: Williams NS, Bulstrode CJK, O’Connell PR, editors. Bailey and Love’s Short practice of surgery. 25th ed. London: Hodder Arnold; 2008.p. 1240–70.

Farquharson M, Moran B. Anal fissures. In: Farquharson’s textbook of operative surgery. 9th ed. London: Arnold; 2005.p. 442–3.

Madoff RD, Fleshman JW. AGA technical review on the diagnosis and care of patients with anal fissure. Gastroenterology 2003;124:235–45.

Richard CS, Gregoire R, Plewes EA, Silverman R, Burul C, Reznick R, et al. Internal sphincterotomy is superior to the topical nitroglycerine in the treatment of chronic anal fissure: results of a randomized controlled trial by the Canadian Colorectal Surgical Trial Groups. Dis Colon Rectum 2000;43:1048–58.

Lamb GF, Driver CP, Morton S, Turnock RR. Fissurectomy as a treatment for anal fissures in children. Ann R Coll Surg Engl 2000;82:254–7.

Ullah S, Nadeem M. Closed versus open lateral internal sphincterotomy in chronic anal fissure: a comparative study of postoperative complications and results. Pak J Med Res 2004;43:1–4.

Mishra R, Thomas S, Maan MS, Hadke NS. Topical nitroglycerin versus lateral internal sphincterotomy for chronic anal fissure: prospective, randomized trial. ANZ J Surg 2005;75:1032–5.

Yucel T, Gonullu D, Oncu M, Koksoy FN, Ozkan SG, Aycan O. Comparison of controlled-intermittent anal dilatation and lateral internal sphincterotomy in the treatment of chronic anal fissures: a prospective, randomized study. Int J Surg 2009;7:228–31.

McDonald PJ, Driscoll AM, Nicholls RJ. The anal dilator in the conservative management of acute anal fissures. Br J Surg 1983;70:25–6.

Zaffar A. Anal dilatation for chronic anal fissure. Professional Med J 2001;8:445–8.

Mousavi SR, Sharifi M, Mehdikhah Z. A comparison between the results of fissurectomy and lateral internal sphincterotomy in the surgical management of chronic anal fissure. J Gastointest Surg 2009;13:1279–8.

Rather SA, Dar TI, Malik AA, Rather AA, Khan A, Parray FQ, et al. Subcutaneous internal lateral sphincterotomy (SLIS) versus nitroglycerine ointment in anal fissure: A prospective study. Int J Surg 2010;8:248–51.

Evans J, Luck A, Hewett P, Glyceryl trinitrate vs. lateral sphincterotomy for chronic and fissure prospective, randomized trial. Dis Colon Rectum 2001;44:93–7.

Libertiny G, Knight JS, Farouk R. Randomized trial of topical 0.2% Glyceryl trinitrate and lateral internal sphincterotomy for the treatment of patients with chronic anal fissure: long-term follow-up. Eur J Surg 2002;168:418–21.

Pernikoff BJ, Eisenstat TE, Rubin RJ, Oliver GC, Salvati EP. Reappraisal of partial lateral internal sphincterotomy. Dis Colon Rectum 1994;37:1291–5.

Oh C, Divino CM, Steinhagen RM. Anal fissure 20 years’ experience. Dis Colon Rectum 1995;38:378–82.

Mentes BB, Tezcaner T, Yilmaz U, Leventoglu S, Oguz M. Results of lateral internal sphincterotomy for chronic anal fissure with particular reference to quality of life. Dis Colon Rectum 2006;49:1045–51