Title: Results of Open Lateral Internal Sphincterotomy for Chronic Anal Fissure: A Case Series
Authors: Anand Deoraj, Kanchan Sonelal Baitha, Prem Prakash
DOI: https://dx.doi.org/10.18535/jmscr/v8i12.23
Abstract
Now a days, eating habits of general public is switching on to low fiber diet leading to constipation and subsequently to anal fissure. It causes ischemia in the anal lining. Constipation, elevated anal pressure and ischemia produces a vicious cycle leading to chronic anal fissure which just refuses to heal causing significant morbidity. The present study aims to evaluate safe and effective surgical method for the treatment of chronic anal fissure in the form of subcutaneous lateral internal sphincterotomy. We conducted a prospective study comprising of 58 patients suffering from chronic anal fissure from June 2017 to June 2019. Subcutaneous lateral internal sphincterotomy was done and patients were evaluated for pain relief, complications and recurrence rates. Almost all patients (94.82%) had complete pain relief after 8 weeks. Per rectal minimal bleeding for 2-3 days post operatively was the most common complication (25-86%) while a temporary incontinence to flatus was seen in 5.1% of the patient. No incontinence to stool was seen. No recurrence was seen in the follow-up period of 8 months. We found subcutaneous lateral sphincterotomy safe and effective treatment method for chronic anal fissure.
References
- Brady JT, Althans AR, Neupane R, et al. Treatment for anal fissure: is there a safe option? Am J Surg. 2017;214:623e628.
- Glover, et al., High-dose circumferential chemodenervation of the internal anal sphincter: a new treatment modality for uncomplicated chronic anal fissure: a retrospective cohort study (with video), Int. J. Surg. 23 (2015) 1e4.
- Wald, et al., ACG clinical guideline: management of benign anorectal disorders, Am. J. Gastroenterol. 109 (8) (2014) 1141e1157
- Perry WB, Dykes SL, Buie WD, Rafferty JF. Standards practice task force of the American Society of Colon and Rectal Surgeons Practice parameters for the management of anal fissures (3rd. revision). Dis Colon Rectum. 2010;53: 1110e1115.
- Nelson RL, Chattopadhyay A, Brooks W, Platt I, Paavana T, Earl S. Operative procedures for fissure in ano. Cochrane Database Syst Rev. 2011;9:CD002199.
- Hsu TC, MacKeigan JM. Surgical treatment of chronic anal fissure. A retrospective study of 1753 cases. Dis Colon Rectum. 1984;27:475e478.
- Poh A, Tan KY, Seow-Choen F. Innovations in chronic anal fissure treatment: a systematic review. World J Gastrointest Surg. 2010;2:231e241.
- Tauro LF, Shindhe VV, Aithala PS, Martis JJ, Shenoy HD. Comparative study of glyceryl trinitrate ointment versus surgical management of chronic anal fissure. Indian Journal of Surgery. 2011 Aug;73(4):268–77.
- Oh C, Divino CM, Steinhagen RM. Anal fissure, 20 year experience. Diseases of the colon and rectum. 1995;38(4):378–82.
- Jonas, et al., Surgical Treatment: Evidence-based and Problem-oriented. Munich: Zuckschwerdt, 2001. Available from: http://www.ncbi.nlm.nih.gov/ books/NBK6878/.
- Araujo SE, Sousa MM, Caravatto PP, Habr-Gamai A, Cecconello I. Early and late results of topical diltiazem and bethanechol for chronic anal fissure: a comparative study. Hepato-Gastroenterology. 2010;57:81e85.
- Shafiq ullah, Muhammad Nadeem, Nishtar Closed versus open lateral internal sphincterotomy in chronic anal fissure: a comparative study of postoperative complications & results. The Pakistan Journal of Medical Research. 2004;43:1.
- Ram E, Vishne T, Lerner I, Dreznik Z. Anal dilatation versus left lateral sphincterotomy for chronic anal fissure: a prospective randomized study. Techniques in Coloproctology. December 2007.