WORLD JOURNAL OF ADVANCE
HEALTHCARE RESEARCH

Dr. Qusay Ahmed Njati Younus*

ABSTRACT

Background: Chronic anal fissure is a common benign anorectal disorder characterized by severe anal pain and rectal bleeding. Although lateral internal sphincterotomy is considered the gold standard surgical treatment, healing outcomes may vary among patients, and several factors may contribute to delayed postoperative recovery. Objectives: To evaluate healing outcomes following surgery for chronic anal fissure and to identify factors associated with delayed healing among patients treated at Al Salam Teaching Hospital, Mosul. Methods: This retrospective cross-sectional study was conducted at Al Salam Teaching Hospital, Mosul, Iraq, from April 2024 to January 2026. A total of 87 patients who underwent surgical treatment for chronic anal fissure after failure of conservative management were included. Demographic, clinical, and operative data were collected from hospital records. Healing outcomes and postoperative complications were assessed during follow-up. Statistical analysis was performed using SPSS version 27. Associations between potential risk factors and delayed healing were evaluated using Chi-square and logistic regression analyses. A P value of less than 0.05 was considered statistically significant. Results: The mean age of the patients was 38.7 ± 11.2 years, and males constituted 56.3% of the study population. Posterior fissures were the most common presentation, accounting for 75.9% of cases. Complete healing was achieved in 76 patients (87.4%), while delayed healing occurred in 11 patients (12.6%). Persistent postoperative pain was reported in 13.8% of patients, whereas recurrence and minor incontinence occurred in 5.7% and 3.4% of cases, respectively. Delayed healing was significantly associated with diabetes mellitus (P = 0.008), smoking (P = 0.021), prolonged symptom duration exceeding six months (P = 0.011), and chronic constipation (P = 0.034). Multivariate logistic regression analysis identified diabetes mellitus (OR = 3.42, 95% CI: 1.18–9.93, P = 0.023), smoking (OR = 3.11, 95% CI: 1.10–8.77, P = 0.031), and symptom duration greater than six months (OR = 2.87, 95% CI: 1.06–7.79, P = 0.038) as independent predictors of delayed healing. Conclusions: Surgical treatment of chronic anal fissure achieved a high healing rate with low recurrence and acceptable postoperative morbidity. Diabetes mellitus, smoking, and prolonged symptom duration were identified as significant independent predictors of delayed healing. Optimization of modifiable risk factors and timely surgical intervention may improve healing outcomes and reduce postoperative complications.

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