Lateral Internal Sphincterotomy versus V-Y Anoplasty in the Treatment of Chronic Anal Fissure: A Comparative Trial Based on Manometry Results

Background: for chronic anal fissure (caf), the first line of treatment is conservative treatment. patients who fail conservative treatment are offered surgical treatment in the form of lateral internal sphincterotomy (lis) or v-y anoplasty. this prospective study aimed to compare lis and v-y anoplasty in the treatment of caf based on the baseline resting anal pressures of patients. methods: female patients with caf were investigated via anal manometry. patients with elevated resting anal pressure were treated with lis, while patients with normal or low resting anal pressure were treated with v-y anoplasty. data regarding the healing of anal fissure, reduction in pain score, continence disturbance, and complications were recorded on follow-up at three months. results: twenty-four female patients with a mean age of 37.6 years were included in this study. sixteen patients underwent lis (group i), while 8 underwent v-y flap (group ii). both groups required comparable time to achieve complete healing. both groups showed significant decreases in pain scores at follow-up (group i: 6.1±0.85 to 0.93±0.7, p<0.0001; group ii: 5.6±0.83 to 0.62±0.7, p<0.0001). similar rates of postoperative fi were recorded in the two groups (6.25% vs. 0%, p=1). significant decreases in anal pressure were noted in group i postoperatively, whereas the change in anal pressure in group ii was not statistically significant. conclusion: both lis and v-y anoplasty achieved excellent outcomes in regard to symptom control and healing of anal fissure. none of the patients who underwent v-y flap developed fi, though 6% of patients who underwent lis developed this complication.