Re-evaluation of lateral subcutaneous sphincterotomy in treating anal fissure

Abstract

Background: Anal fissure is a common disease and has a myriad of treatment options. The aim of this study was to re-evaluate lateral subcutaneous sphincterotomy in the treatment of anal fissure. Patients and Methods: We retrospectively studied143 patients with chronic anal fissure at King Abdulaziz University Hospital between March 1995 and April 2011, to determine the outcome of lateral subcutaneous sphincterotomy. These patients were studied using file data, operative notes, post operative course, OPD follow up. Variables studied were age, sex, nationality, History of previous surgery, recurrence, open or closed sphincterotomy, healing of wound, duration of healing [weeks], post op pain, post op bleeding, incontinence of flatus, liquid or solid stool, length of incontinence, duration of surgery, and weather admitted or treated as a day case. Results: In our study the youngest patient was 18 years old and the oldest 67 years old with mean age 42.5 years. Majority were females 65% and males 35%. Saudis were 52.4% and non Saudis were 47.5%. 55.4% of patients had previous surgery. Recurrence occurred in 5.4% of patients. 42.3% underwent closed surgery and 57.7% open surgery. Duration of operation was minimum 4 minutes and maximum 25 minutes with mean duration of 14.5 minutes. 11.9% of patients needed admission while 88.1% were treated as day case. Healing occurred in 72.8% while 27.2% did not have healing of wounds. Majority of wound healed in one week-57.6% and 18.4 had healing in two weeks while longest healing occurred in 52 weeks. Longest follow up was 180 weeks. Post op pain occurred in 50% of cases and no pain in 50% of cases. Post op bleeding occurred in 23.9% of patients. There was no incontinence in 80.4% of cases while 14.1 % of patients had incontinence of flatus, 4.3% of liquid stools 1% incontinence of solid stool. Length of incontinence was one to sixteen weeks. In 16.3% cases incontinence was resolved and in 3.2% cases it did not resolve. 73.9% of patients expressed satisfaction of treatment while 17.3% were partially satisfied and 8.6% patients were not satisfied with the treatment. Conclusion: Lateral sphincterotomy is a safe, effective treatment of anal fissure and evolving as a gold standard treatment for chronic anal fissure.