Five-year results of fissurectomy for chronic anal fissure : low recurrence rate and minimal effect on continence

Aim The aim of the study was to determine the long-term outcome, recurrence rate and faecal incontinence score after fissurectomy for chronic anal fissure (CAF) not responding to conservative treatment. Method Fifty-three consecutive patients (29 women) who underwent fissurectomy for a medically resistant CAF between 1998 and 2005 were included in the study. At a minimum follow-up of 5 years a standardized questionnaire was sent to all patients, assessing recurrence, satisfaction with the operation (on a scale of 010) and faecal continence (Vaizey score, 024). The patients were compared with a control group of 50 healthy volunteers, matched for sex and age, who had never undergone anal surgery. Results Forty-three (81%) patients (25 women) returned the questionnaire. The mean age was 40 (SD 12.1) years and median follow up was 8.2 (5.5-12.2) years. Five patients had a recurrent CAF (11.6%). Ninety per cent of patients would have consented to the operation again if necessary. The mean Vaizey score at follow-up was 2.5 (SD +/- 4.2). The mean Vaizey score of the four patients who had had a previous lateral sphincterotomy was 3.8 and for the eight patients who had reported a continence disturbance before fissurectomy it was 8.3. The mean Vaizey score of the 31 patients who were continent before fissurectomy was 0.8 compared with 0.4 in the control group (P = 0.9). Conclusion At 5 years or more fissurectomy for medically resistant CAF is effective with a low recurrence rate and minimal influence on continence.