Efficacy of closed internal sphincterotomy using von grafae knife in the management of chronic anal fissures

Abstract

Background:Fissure in ano is one of the commonest benign and painful proctologic diseases causing considerable morbidity and reduction in quality of life. There are medical as well as surgical treatment options for anal fissure. The present study was conducted to find out the efficacy of closed internal sphincterotomy using von grafae knife for the management of chronic anal fissures.Methods: This was a study conducted at Department of surgery, KR hospital, Mysore, Karnataka, India from June 2016 to November 2016 for a period of six months. 70 patients with chronic anal fissure were randomly assigned into group A (35 patients) and group B (35 patients). Group A patients underwent open sphincterotomy, group B closed sphincterotomy using VON grafae knife. After matching the baseline characteristics; post op pain, wound infection, hematoma, fecal and flatus incontinence were compared. Data was analysed using SPSS-16.Results:3 out of 35 patients had wound infection in group A, none had infection in group B. 10 out of 35 (28%) developed flatus incontinence temporarily in group A, 6 out of 35 (17%) in group B. 2 out of 35 (5.7%) had fecal continence in group A, none had it in group B but incontinence was temporary. Pain (VAS>6) was more in group A (24) than group B (15). One patient had hematoma as a complication in group B.Conclusions:Closed internal sphincterotomy using von grafae knife is a better technique compared to open technique in terms of pain, wound infection, incontinence.