A Prospective Study On Closed Lateral Internal Sphincterotomy In Chronic Anal Fissures

• ORIGINAL ARTICLE | ISSUE DETAILS: VOL NO.2 | ISSUE NO. 1

Abstract

Background: An anal fissure is a longitudinal rupture in the mucosa of the lower anal canal that results in slight bleeding when hard stool is passed and uncomfortable defecation. It is linked to the traditional trio of hypertrophy papilla, sentinel tag, and anal ulcer. Anal dilatation has been the conventional treatment for this prevalent issue—the present research aimed to determine the rate of complications, healing, and pain alleviation.

Objective: to investigate the course of healing, pain management, and related consequences after a closed internal sphincterotomy for a persistent anal fissure.

Material & Methods: From July 2015 to June 2017, this research was carried out at the Mardan Medical Complex Mardan at the Department of Surgery. The research included patients of either sex who had a persistent anal fissure. Patients with uncontrolled diabetes or on anticoagulant treatment, as well as those with a history of sphincterotomy, anal dilatation, and suspicion of malignant fissure, atypical fissure, or ulcer with accompanying abscess, were not allowed to participate in the research. Every patient had a closed internal sphincterotomy, followed by follow-up visits every two, six, and twelve weeks. Pre-made proforma were used to capture the data, and SPSS version 16 was used for analysis. Frequencies and percentages were computed for qualitative variables, and for quantitative data, mean and standard deviation.

Results: 68 of the 71 patients who were admitted got full follow-up. A ratio of 1.6 to 1. 51 patients, or 75% of the total, reported discomfort during defecation; 37 patients, or 54%, reported bleeding, and 4 patients, or 6%, reported pruritis. A week after the operation, discomfort persisted in 2 patients (2.9%), whereas 66 patients (97%) had total pain relief in 24 hours. In two of the four patients, bleeding and hematoma wound infection were seen. Two individuals had transient flatus incontinence, but no faecal incontinence was seen. Within six weeks, the fissure had completely healed in all 68 patients. 

Conclusion: When a chronic anal fissure is treated with closed lateral internal sphincterotomy, there is little chance of complications and rapid symptom relief.