Outcome of Bilateral Segmental Internal Anal Sphincterotomy for Treatment of Chronic Anal Fissure

Abstract

Background: Chronic anal fissures are harder to treat, and surgery may be the best option. The goal of surgery is to help the anal sphincter muscles relax which reduces pain and spasms, allowing the fissure to heal. Objective: The aim of the present study was to assess the improving outcome of patients of chronic anal fissure. Patients and methods: This study included 18 patients with chronic anal fissure admitted at Department of General Surgery, Faculty of Medicine, Zagazig University. All patients were subjected to full history taking, proper local examination and baseline investigations. Anorectal manometry was performed for all patients preoperatively and bilateral segmental internal sphincterotomy was done for all patients. Results: The present study showed that 88.9% had constipation, 100.0% had pain and 77.8% had bleeding defecation. Duration was distributed as 7.55 ±2.68 with minimum 4 and maximum 14 months and the majority were between 6-12 months. Complete healing was distributed as 5.16 ±1.09 with maximum 8 weeks. Visual Analogue Scale (VAS) significantly decreased from pre to 1st 24 hours tell the end of follow up . Incontinence score significantly decreased from pre to 1st week tell the end of follow up. Conclusion: It could be concluded that bilateral segmental internal sphincterotomy takes some extra time for the procedure and significantly a good procedure in treatment of chronic anal fissures in terms of early pain relief, reduction of resting anal pressure and complete healing rate in 5 weeks. The risks of incontinence and recurrence of fissure are negligible with superior patients’ satisfaction.