Lateral Internal Sphincterotomy for Treatment of Chronic anal Fissure in Paediatrics

Abstract

Aims: Lateral internal sphincterotomy is a well established surgical technique for treatment of chronic anal fissure in adult. We performed this study to evaluate the outcome of lateral internal sphincterotomy in Paediatrics. Patients and Methods: This is a prospective study performed over a period of 4 years from October 2008 to October 2012 on 37 patients with chronic anal fissure of a duration exceeding 3 months and history of failure to conservative treatment. All patients underwent left lateral internal sphincterotomy through an open technique. Outcome was evaluated by assessing the effectiveness of this procedure in relieving the symptoms, fissure healing, parents’ satisfaction and complication rate. Results: There were 26 boys and 11 girls, mean age was 11 months with a range of (6 months - 12 years), and symptoms were relieved within 2 weeks in 28 cases and within one month in 5 cases. 4 patients require postoperative oral laxative for 1-3 months to overcome the withholding behavior. Fissures were healed in 34 by 8 weeks postoperatively. Parent satisfied with the outcome in 32 patients. 4 patients developed postoperative bleeding and only one of them was serious and required cauterization, soiling occurred in 3 cases. No permanent incontinence was reported. Conclusion: Lateral internal sphincterotomy is an effective and safe surgical technique for treatment of chronic anal fissure not responding to medical treatment in paediatric. Complications are uncommon and the risk of incontinence is very minimal if proper surgical technique is performed.