Abstract
Introduction: Chronic anal fissure (CAF) is one of the most common proctologic conditions seen in surgery and is the most common cause of perianal pain. The surgical procedure of choice is lateral internal sphincterotomy (LIS) which usually provides a permanent cure for CAF. The fear of causing incontinence restricts many surgeons from performing LIS for managing CAF. The objective of our study is to evaluate the outcome of LIS in treating CAF in terms of fissure healing and reduction in resting anal pressure (RAP), as well as the incidence of anal incontinence following the procedure. Materials and Methods: A prospective study was conducted among 43 patients with CAF who underwent LIS. Anal manometry of the patients was done and results were noted preoperatively as well as at 6 weeks postoperatively. Patients were followed up and symptom relief, healing of fissure and incontinence to flatus or stool if present were noted on post-operative day, 1 week after surgery and 6 weeks after surgery. Results: Fissure healed in all 43 patients who underwent LIS in our institute. Hence, we observed a 100% healing rate following the procedure. RAP was found to be raised in all patients with CAF who required surgical treatment with a mean pre-operative RAP of 86.6 mmHg (normal 40–60 mmHg.). There was a significant reduction in RAP after the LIS surgery with a P < 0.001. The mean post-operative RAP was 53.16 mmHg which is in the normal range. Only one patient (2.3%) developed post-operative anal incontinence in our study. He was also managed conservatively with no permanent incontinence. Conclusions: We conclude that LIS is the surgical treatment of choice for CAFs, as it gave a 100% healing rate with a very low incidence of post-operative anal incontinence and other complications.
Published Version
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