Abstract
Background: One of the the most common cause of pain during defecationin young patientsis chronic fissure in ano. Surgical treatment of choice for chronic fissure in ano is internal sphincterotomy. This procedure can be performed by open or closed method. The aim of the study was to compare the closed and open anal internal sphincterotomy in patients admitted in our hospital with chronic anal fissure. Subjects and Methods: 105 patients admitted in department of general surgery with chronic fissure in ano were divided into two groups. 50 patients (Group A) who were treated by closed method and 55 patients (Group B) who were managed by open lateralanal sphincterotomy method. A 3 months follow up done in both post-surgery to observe for pain, bleeding, infection, incontinence, and recurrence. Results: Significant difference was observed in postoperative acute complications between the two methods of internal anal sphincterotomy. Conclusion: Lateral anal sphincterotomy is the treatment of choice for chronic anal fissure, either open or closed method. However, the closed method was observed to have lesserpost operative complication compared to the open method.
Highlights
Fissure in ano is a painful condition of anoderm
Anal canal was retracted using park retractor and intersphincteric groove is felt. 1-cm incision was made in the intersphinc tericgroove and an artery forceps was used to separate the muscle from the mucosa and the lower third is divided followed by pressure for 3 min to control bleeding
The peak incidence of chronic fissure in ano was between 25 - 35 years
Summary
Fissure in ano is a painful condition of anoderm. Increased tone of internal anal spincter along with tissue hypoperfusion is the cause of development of chronic fissure in ano. [1,2] Fissure in ano is divided into acute and chronic. Hypertrophic anal papillae, anal spasm or fibrosis of the internal sphincter muscle are certain features of chronic fissure in ano. Crohn’s disease, anal intercourse, sexually transmitted disease, or anal carcinoma are certain conditions which can present with multiple fissures in ano. Lateral anal sphincterotomy (LAS) is the surgical treatment of choice in patients with chronic anal fissure where medical management fails. This procedure may be performed either by open or closed method. By 6 weeks post operativeperiod , 94.7–96% of fissures heal with a low recurrence rate. [5,6,7] 5 years failure rates is seen in 2-3%. [8]
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