Efficacy of Lateral Internal Sphincterotomy in Treating Chronic Anal Fissure
Muhammad Faizan, Saeed Ahmad, Zainab Zafar, Muhammad Khurram Zia, Maria Shaikh
1138
ABSTRACT
Aim of the study: To determine the
effectiveness of lateral internal sphincterotomy in the treatment of chronic
anal fissures resistant to pharmacological treatment (chemical sphincterotomy)
in terms of recovery time, frequency of recurrences and complications.
Study design: This was a
prospective descriptive study.
Place and duration:In the Department of
Surgery,Lahore General Hospital, Lahore during the time period fromJanuary 2021
to August 2021.
Material and methods: The study included 80
patients with chronic anal fissure, regardless of age and sex, after the
history and clinical examination. All these patients were operated on under
general or spinal anesthesia after obtaining consent and routine examinations.
Lateral internal sphincterotomy was performed and patients with OPD were
followed for 6 to 8 weeks to determine the benefit of the procedure.
Results: The study included 57
men and 23 women (M: F ratio 2.2: 1) with a history of pain, bleeding,
discharge with or without sentinel tagduring defecation. The average age was 36
and ranged from 20 to 55. The fissure was found in the majority of patients at
6 O clock position (91.2% for men and 52.2% for women). The duration of
symptoms was longer in women due to social problems. LIS was used in all
patients. Patients were followed in OPD at weeks 1, 2, 4 and 6. Most of the
patients fully recovered after 4 weeks. Occasional constipation occurred in 31
(54.4%) men and 11 (47.8%) women. The study found crater ulcers in all 80
patients. All patients had a history of
painful bowel movements (100%), but 24 men (42.1%) and 12 women (52.2%) had
bleeding and discharge. In 51 male patients (89.5%), the fissure was in the
posterior and anterior midline in 3 patients (13.1%). Half of the patients had
anterior fissure and the other half had posterior fissures. The sentinel tag
was observed in 46 (80.7%) men and 17 (73.9%) women. 11 (19.3%) men and 6
(26.1%) women reported liquid stool incontinence, while 15 men (26.3%) and 9
women (16.9%) reported flatus incontinence. No relapse was observed in all
patients after 4 months.
Conclusion: As long as the
patient is willing to accept the risk of transient fecal incontinence, we can
accept the Gold Standard of Treatment (LIS) as first-line therapy for chronic
anal fissure.
Keywords: Lateral internal
sphincterotomy, Chronic anal fissure, Fecal incontinence.
ABSTRACT
Aim of the study: To determine the
effectiveness of lateral internal sphincterotomy in the treatment of chronic
anal fissures resistant to pharmacological treatment (chemical sphincterotomy)
in terms of recovery time, frequency of recurrences and complications.
Study design: This was a
prospective descriptive study.
Place and duration:In the Department of
Surgery,Lahore General Hospital, Lahore during the time period fromJanuary 2021
to August 2021.
Material and methods: The study included 80
patients with chronic anal fissure, regardless of age and sex, after the
history and clinical examination. All these patients were operated on under
general or spinal anesthesia after obtaining consent and routine examinations.
Lateral internal sphincterotomy was performed and patients with OPD were
followed for 6 to 8 weeks to determine the benefit of the procedure.
Results: The study included 57
men and 23 women (M: F ratio 2.2: 1) with a history of pain, bleeding,
discharge with or without sentinel tagduring defecation. The average age was 36
and ranged from 20 to 55. The fissure was found in the majority of patients at
6 O clock position (91.2% for men and 52.2% for women). The duration of
symptoms was longer in women due to social problems. LIS was used in all
patients. Patients were followed in OPD at weeks 1, 2, 4 and 6. Most of the
patients fully recovered after 4 weeks. Occasional constipation occurred in 31
(54.4%) men and 11 (47.8%) women. The study found crater ulcers in all 80
patients. All patients had a history of
painful bowel movements (100%), but 24 men (42.1%) and 12 women (52.2%) had
bleeding and discharge. In 51 male patients (89.5%), the fissure was in the
posterior and anterior midline in 3 patients (13.1%). Half of the patients had
anterior fissure and the other half had posterior fissures. The sentinel tag
was observed in 46 (80.7%) men and 17 (73.9%) women. 11 (19.3%) men and 6
(26.1%) women reported liquid stool incontinence, while 15 men (26.3%) and 9
women (16.9%) reported flatus incontinence. No relapse was observed in all
patients after 4 months.
Conclusion: As long as the
patient is willing to accept the risk of transient fecal incontinence, we can
accept the Gold Standard of Treatment (LIS) as first-line therapy for chronic
anal fissure.
Keywords: Lateral internal
sphincterotomy, Chronic anal fissure, Fecal incontinence.