Lateral Sphincterotomy Research Articles

Surgical management of post hemorrhoidectomy benign anal stenosis - an experience of eleven patients

Anal stenosis is a serious but fortunately rare complication of anorectal surgical procedures. It has been shown that approximately 90% of anal stenosis develops after hemorrhoidectomy, and 1.5-3.8% of all hemorrhoidectomies. The surgical methods such as stricture release, sphincterotomy and advancement flap are common techniques to repair anal stenosis. This is a retrospective observational study of 11 patients with benign anal stenosis managed surgically from January 2017 to April 2022. A total of 11 patients (nine males and two females), mean age 45.6 years (range- 33-90 years), underwent various surgical procedures like partial lateral internal sphincterotomy (PLIS) (n=04), V-Y flap anoplasty (n=03) and diamond flap anoplasty (n=04) with PLIS in both types of anoplasties as an associated procedure. After follow up period of two months to three years, all patients of PLIS had 100% healing rate, V-Y flap anoplasty had 66% healing rate with re-stenosis in one patient and diamond flap anoplasty had 100% healing rate with no restenosis. In moderate to severe anal stenosis and failed conservative management, various anoplasty techniques can be used with lateral sphincterotomy with good results, especially diamond flap anoplasty.

Comparison between open lateral sphinectomy and posterior midline sphinectomy with Fissecrectomy in treatment of chronic anal fissure

Objective: to compare the outcomes between two methods of treating chronic anal fissure; open lateral internal sphincterotomy (LIS) with fissurectomy versus posterior midline sphincterotomy (PIS) with fissurectomy, in terms of post-operative complications. Study design: Randomized control trial Place and duration: surgery department of Nishtar Hospital Multan from 10th February 2019 to 9th February 2020 in one year duration. Methodology: Patients presented at outpatient department of hospital and diagnosed as chronic anal fissure were enrolled in study and divided into two groups for treatment. Group A was treated with open lateral sphinectomy with fissurectomy and group B was treated with posterior midline sphinectomy with fissurectomy. SPSS version 23 was used for data analysis. Results:In LIS Group, the most common post-operative complication was infection 34.8%. The most common complication in PIS Group was also infection 77.8%. The differences were statistically significant for infection (p=0.000), bleeding (p=0.008) and bruising (p=0.000). Conclusion: No differences was observed between lateral internal sphinectomy and posterior midline spinectomy in term of healing rates, symptomatic pain relief and the side effect occurrence after surgeries.

Comparison of Pain Score in Open Hemorrhoidectomy with and without (Lateral Internal Sphincterotomy) LIS

Comparison of Pain Score in Open Hemorrhoidectomy with and without (Lateral Internal Sphincterotomy) LIS

Comparing closed versus open lateral internal sphincterotomy for management of chronic anal fissure: systematic review and meta-analysis of randomised control trials

Chronic anal fissure is one of the most common benign anorectal health conditions, causing significant morbidity, quality of life, and economic loss. Eight randomized controlled trials with a total population size of 1035 were eligible for analysis. Seven studies included both males and female, while one only included females. The majority of randomized controlled trials involved female dominance [54.9% (43.5–66.3)] and posterior midline location [86.1% (95% CI 81.5–90.8%)]. This meta-analysis of randomised control trials found that overall postoperative healing was 90.2%, recurrent anal fissure was 3.7%, and postoperative incontinence was 8.9% after LIS. Even though there was no statistically significant difference, closed lateral internal sphincterotomy (LIS) had higher rates of recurrent anal fissure (RR = 1.73 (95% CI 0.86–3.47, p = 0.90, I2 = 0%) and lower rates of postoperative incontinence rate (RR = 0.60 (95% CI 0.37–0.96, p = 0.76, I2-0) as compared with open LIS. We recommended that closed lateral internal sphincterotomy (LIS) is a safe and effective surgical treatment option for chronic anal fissures.

Comparative study of laser versus open lateral internal sphincterotomy in the treatment of anal fissure

Background: Anal fissure is a common proctological problem that causes anal pain during and after defecation. An anal fissure is a linear ulcer that presents at the anal verge. It is more common in females than males and can be seen either in the anterior or posterior midline, just distal to the dentate line. Aims and Objectives: Comparison of Laser versus Open lateral internal sphincterotomy (LIS) in the treatment of anal fissures. Materials and Methods: The study was conducted in 50 cases of Open LIS compared with 50 cases of laser LIS (LLIS) in patients admitted to the Department of Surgery, M.L.B. Medical College, Jhansi (UP), India, between January 2021 and June 2022. Results: Out of 50 cases of open LIS, 10 patients presented with bleeding, 10 patients presented with hematoma/perianal swelling and 5 patients presented with pain as compared to 50 cases of LLIS, hematoma/perianal swelling (1 patient) and pain (2 patients) were found as an early post-operative complication. Mean hospital stay was 2.84±1.128 days in Open LIS as compared to 1.02±0.141 days in LLIS. The pain was presented in 1 patient as the only late post-operative complication in LLIS as compared to pain (25 patients), bleeding (10 patients), infection (2 patients), and flatus incontinence (1 patient) in Open LIS, at 2 weeks follow-up and recurrence in 1 patient in laser and in 3 patients in open LIS at 6 weeks follow up. Conclusion: LLIS significantly reduces early postoperative complications such as postoperative pain, bleeding, and hematoma as compared to open LIS. The duration of hospital stay was significantly less in LLIS in comparison to open LIS. None of the patients presented with the flatus or stool incontinence who had undergone LLIS while in Open LIS, 12% of patients presented with flatus incontinence, and 2% of patients presented with stool incontinence during follow-up in 2–6 weeks.

Pudendal block effect on pain perception after lateral sphincterotomy for chronic anal fissure done under general anesthesia: a randomized controlled trial

Pudendal block effect on pain perception after lateral sphincterotomy for chronic anal fissure done under general anesthesia: a randomized controlled trial

Surgeons' practice and preferences for the anal fissure treatment: results from an international survey.

The best nonoperative or operative anal fissure (AF) treatment is not yet established, and several options have been proposed. Aim is to report the surgeons' practice for the AF treatment. Thirty-four multiple-choice questions were developed. Seven questions were about to participants' demographics and, 27 questions about their clinical practice. Based on the specialty (general surgeon and colorectal surgeon), obtained data were divided and compared between two groups. Five-hundred surgeons were included (321 general and 179 colorectal surgeons). For both groups, duration of symptoms for at least 6weeks is the most important factor for AF diagnosis (30.6%). Type of AF (acute vs chronic) is the most important factor which guide the therapeutic plan (44.4%). The first treatment of choice for acute AF is ointment application for both groups (59.6%). For the treatment of chronic AF, this data is confirmed by colorectal surgeons (57%), but not by the general surgeons who prefer the lateral internal sphincterotomy (LIS) (31.8%) (p = 0.0001). Botulin toxin injection is most performed by colorectal surgeons (58.7%) in comparison to general surgeons (20.9%) (p = 0.0001). Anal flap is mostly performed by colorectal surgeons (37.4%) in comparison to general surgeons (28.3%) (p = 0.0001). Fissurectomy alone is statistically significantly most performed by general surgeons in comparison to colorectal surgeons (57.9% and 43.6%, respectively) (p = 0.0020). This analysis provides useful information about the clinical practice for the management of a debated topic such as AF treatment. Shared guidelines and consensus especially focused on operative management are required to standardize the treatment and to improve postoperative results.

Nigam’s standardization of manual anal dilatation (Lord’s procedure)

Background: Standardisation of manual anal dilatation. It was a quality improvement study. Patients were admitted in various hospitals of Gurgaon, Haryana, India. Methods: Two hundred thirty-six patients of fissure in ano were treated by manual anal dilatation (Lord’s procedure) as per Nigam’s standardization between January 2010 and January 2022. Informed consent was obtained from each patient. All patients were evaluated for post procedure for complications. Two hundred thirty-six patients of fissure in ano were treated by manual anal dilatation (Lord’s procedure). Results: No patient developed faecal incontinence. Pain subsided immediately in all patients. No patient had non healing of anal fissure. Two patients had mild gas incontinence which resolved after 3-4 days. None of the patients required lateral sphincterotomy or fissurectomy. Most of the patients healed completely within three weeks. Conclusions: If manual anal dilatation is performed slowly, gently with controlled force for four minutes, as per Nigam’s standardisation then results are very good. This study includes patients of acute and chronic fissure in ano. The study excludes cases of anal cancer, stage III and IV haemorrhoids and inflammatory bowel disease.

Early outcomes of chronic anal fissure treatment using the lateral internal sphincterotomy method without excision (randomized trial NCT05117697)

PURPOSE OF THE STUDY: improvement of the treatment of chronic anal fissure results.PATIENTS AND METHODS: the study included 70 patients randomized by random number generation into 2 groups: 30 patients underwent lateral internal sphincterotomy (main group, LIS), and 40 patients underwent LIS in combination with the excision of the fissure (EF) (control group, LIS + EF).RESULTS: the pain intensity both after stool and during the daytime in the main group (LIS) has been significantly lower than in the control group (LIS + EF) (p < 0.05). The median duration of the patients’ temporary disability in the LIS group was 6 (4; 9) days, in the LIS + EF group — 17 (9; 23.5) days (p = 0.04). On day 15, the defect has epithelialized in 12/30 (40%) patients of the main group (LIS) and none (0/40) in the control group (LIS + EF) (p = 0.00001), on day 30 — in 22/30 (73.3%) and 2/40 (5%) (p = 0.00001), on day 45 — in 26/30 (87%) and 20/40 (50%) (p = 0.002), and on day 60 — in 28/30 (93.3%) and 38/40 (95%) (p = 1.0), respectively. On the day 30 after surgery, 3/30 (10%) patients of the main group and 15/40 (37.5%) of the control group had complaints regarding passing gas (p = 0.01), on day 60 — anal sphincter insufficiency (ASI) persisted in 1/30 (3%) patients in the LIS group and in 3/40 (7.5%) patients in the LIS + EF group (p = 0.63). Excision of the fissure in 5.4 (1.4–20.9) times increases the chance of developing ASI on day 30 of the postoperative period (p = 0.015) and 52 (10.2; 268.3) times increases the chance of non-healing of the defect during this period (p = 0.000002) and 6.5 (1.9; 22) times on the day 45 (p = 0.003), in comparison with the LIS only.CONCLUSION: refusal to excise the anal fissure during its surgical treatment and perform the lateral internal sphincterotomy only can reduce the intensity of postoperative pain syndrome, the rate of postoperative complications and reduce the time of epithelialization of the anoderm defect.

Open or closed sphincterotomy for treatment of the chronic anal fissure? (systematic review and meta-analysis)

INTRODUCTION: up to the present time, both open and closed lateral internal sphincterotomy (LIS) are considered by surgeons as fully comparable methods for eliminating the spasm of the internal sphincter in patients with chronic anal fissure. However, each method has a number of advantages and disadvantages. AIM: determination of an effective and safe method of lateral subcutaneous sphincterotomy.MATERIALS AND METHODS: a systematic overview and meta-analysis of studies, which compare the results of treatment after an open and closed lateral sphincterotomy was performed. The following has been evaluated: the incidence of fissure epithelialization, the postoperative morbidity, the recurrence rate, the incidence of anal incontinence (AI). Statistical processing has been carried out in the Review Manager 5.3 program.RESULTS: the meta-analysis included 9 studies with the results of treatment of 452 patients after an open lateral sphincterotomy and 443 after a closed one. The groups were comparable in frequency of epithelialization of fissures (OR = 0.87; CI = 0.30; 2.53; p = 0.8), in terms of the number of postoperative complications (OR = 0.52; CI = 0.15; 1.76; p = 0.29), as well as the number of relapses of the disease (OR = 0.5; CI = 0.19; 1.31; p = 0.16). At the same time, the implementation of an open lateral sphincterotomy leads to the development of AI 2.05 times more often than the closed method (OR = 2.05; CI = 1.01; 4.16; p = 0.05).CONCLUSION: during the treatment of the chronic anal fissure, in order to eliminate the spasm of the internal sphincter, it is advisable to use a closed method, in which the chance of AI is 2.05 times lower.

A Prospective Study To Evaluate Medical Management Vs Surgical Intervention In Pain Relief And Healing Of Anal Fissure

Introduction: Anal fissure is a commonly encountered problem for surgeons. It is a longitudinal tear in distal anal canal with or without an ulcer. It causes significant changes in quality of life. This study was done to compare the efficacy of medical management and surgical intervention in cases of anal fissures. Methods: 50 patients were divided into two groups of 25 each. Group A patients were treated with topical application of 2% diltiazem gel and Group B patients were treated with Lateral sphincterotomy. Both groups were examined weekly for 4 weeks for pain using VAS score and at 12 weeks for healing. Results: 21(84%) patients were pain free after 4 weeks under Group A, 24 (96%) patients were pain free after 4 weeks under Group B. 22(88%) patients were completely healed at 12 weeks under Group A, 25(100%) patients were completely healed at 12 weeks under Group B. Conclusion: Lateral sphincterotomy can be advocated as treatment of choice for anal fissures. It has better pain relief and healing rates compared to topical application of 2% diltiazem gel. Medical Management can be used in patients refusing surgery or unfit for surgery

Combining Milligan-Morgan Technique with Left Lateral Sphincterotomy for Better Outcomes in Prolapsed Hemorrhoids

Combining Milligan-Morgan Technique with Left Lateral Sphincterotomy for Better Outcomes in Prolapsed Hemorrhoids

CLINICAL STUDY OF CHRONIC FISSURE-IN-ANO AND COMPARATIVE STUDY OF DIFFERENTMODALITIESOF ITS TREATMENT IN NMCH&RC

Anal fissure is a most common painful condition whichcauses considerable morbidity and affects the patients quality of life to a greater extent. The majority of acute anal fissures heal spontaneously. However, some of the acute anal fissures do not resolve but become chronic. Thiswarrantsprompttreatmentof the condition with appropriatemethods.Selecting a better method of treating this condition that can achieve optimal clinical results and getting the least pain and inconvenience to the patient has always posed a challenge to the surgeons. This has led to the innovation of a number of surgical and pharmacological methods that relaxes the anal sphincter. Aimof The Study:To study the different clinical presentations and etiological factors of the fissure in ano& different modalities of treatment of fissure in ano i.e., application of 2% Diltiazem ointment, Lords Anal Dilatation and Subcutaneous Lateral Internal Sphincterotomy. &to evaluate the efficacy Subcutaneous Lateral Internal Sphincterotomyas a treatment modality in the management of chronic anal fissure in comparison with application of 2% Diltiazem ointment & with Lords Anal Dilatation. Materials & Methods: The material for the study was taken from the cases attending thesurgery OPD and admitted In-patients of all the units of the Department of General Surgery, Navodaya Medical College Hospital & Research Centre,whowerediagnosed to haveChronicanal fissure. This study was a prospective study which included 90 patients presenting with chronic anal fissure over a period of 18 months from November 2019 to May 2021.Thesepatientswererandomly selectedandclassifiedintothree groups(A,B,C) eachconsistingof30 patients & each group with one type of treatment modality, like group A for 2% diltiazem, B for lords anal dilatation & C for LIS. Follow-up of the patients was done by history and per-rectalexamination to assess the efficacy of the treatment and the complications like pain,bleeding,sphincter spasm, dischargeperanum and incontinence. Results :This study showed the results in favour of Lateral Internal Sphincterotomywith a healing rate of 100% with faster pain-relief and minimal or no complications ifperformedbythehands of an experienced surgeon, whereas latency in the clearance of symptoms and lesions was seen with 2% Diltiazem and Lords Anal Dilatation with adverse effects as well. With the healingrate of 100% of Fissure-in-ano in LIS therapy group, 81% in Lords Anal Dilatation and 71% with topical 2% Diltiazem therapy, & adverse effects or complications being maximum in 2% Diltiazem therapy group, 13 patients (46%) when compared to Lords Anal Dilatation (41% , 11 patients) and LIS group (32%, 09 patients), weconcludethatLateralinternalsphinterotomy(LIS) appearstobethebetterlineoftreatmentasthereis 100%healingrate, minimal complications and no recurrence.

CLINICAL STUDY OF CHRONIC FISSURE-IN-ANO AND COMPARATIVE STUDY OF DIFFERENTMODALITIESOF ITS TREATMENT IN NMCH&RC

Anal fissure is a most common painful condition whichcauses considerable morbidity and affects the patients quality of life to a greater extent. The majority of acute anal fissures heal spontaneously. However, some of the acute anal fissures do not resolve but become chronic. Thiswarrantsprompttreatmentof the condition with appropriatemethods.Selecting a better method of treating this condition that can achieve optimal clinical results and getting the least pain and inconvenience to the patient has always posed a challenge to the surgeons. This has led to the innovation of a number of surgical and pharmacological methods that relaxes the anal sphincter. AimofThe Study:To study the different clinical presentations and etiological factors of the fissure in ano& different modalities of treatment of fissure in ano i.e., application of 2% Diltiazem ointment, Lords Anal Dilatation and Subcutaneous Lateral Internal Sphincterotomy. &to evaluate the efficacy Subcutaneous Lateral Internal Sphincterotomyas a treatment modality in the management of chronic anal fissure in comparison with application of 2% Diltiazem ointment & with Lords Anal Dilatation. Materials & Methods: The material for the study was taken from the cases attending thesurgery OPD and admitted In-patients of all the units of the Department of General Surgery, Navodaya Medical College Hospital & Research Centre,whowerediagnosed to haveChronicanal fissure. This study was a prospective study which included 90 patients presenting with chronic anal fissure over a period of 18 months from November 2019 to May 2021.Thesepatientswererandomly selectedandclassifiedintothree groups(A,B,C) eachconsistingof30 patients & each group with one type of treatment modality, like group A for 2% diltiazem, B for lords anal dilatation & C for LIS. Follow-up of the patients was done by history and per-rectalexamination to assess the efficacy of the treatment and the complications like pain,bleeding,sphincter spasm, dischargeperanum and incontinence. Results :This study showed the results in favour of Lateral Internal Sphincterotomywith a healing rate of 100% with faster pain-relief and minimal or no complications ifperformedbythehands of an experienced surgeon, whereas latency in the clearance of symptoms and lesions was seen with 2% Diltiazem and Lords Anal Dilatation with adverse effects as well. With the healingrate of 100% of Fissure-in-ano in LIS therapy group, 81% in Lords Anal Dilatation and 71% with topical 2% Diltiazem therapy, & adverse effects or complications being maximum in 2% Diltiazem therapy group, 13 patients (46%) when compared to Lords Anal Dilatation (41% , 11 patients) and LIS group (32%, 09 patients), weconcludethatLateralinternalsphinterotomy(LIS) appearstobethebetterlineoftreatmentasthereis 100%healingrate, minimal complications and no recurrence.

Botulinum toxin injection in outpatients for chronic anal fissure

Objectives The aim of the study was to evaluate the effect of botulinum toxin (BT) injection on fissure healing in the treatment of chronic anal fissure (CAF) in outpatient conditions without any analgesia and sedation to the internal anal sphincter (IAS). The primary outcome measure was post-procedural pain. The secondary outcome measures were fissure healing and complications. Methods Prospectively preserved data of 67 patients who received BT injections for CAF were analyzed prospectively. Demographic data, duration of symptomatic improvement, fissure location and number, parity, post-procedural pain, complications, continence status, response to treatment, and duration of follow-up were examined. Participants received bilateral (50 + 50 units) BT injections into the internal anal sphincter (IAS) in an outpatient setting. Results Symptomatic improvement was observed in 58% of patients within 1 week. The complete response rate to treatment was 82% at a mean follow-up of 6 months. Patients with partial response to treatment (10%) were successfully treated with topical therapy, and patients with persisting fissures (8%) were successfully treated with partial lateral internal sphincterotomy (LIS). 14 patients (21%) reported some degree of transient incontinence at follow-up. Multiparous women experienced more symptoms of Incontinence (p = 0.00). Pre- and post-procedural Vas Score median values were 4. The 7th-week VAS score median value was 3. Conclusion Dysport injection under sedation-free outpatient conditions is an effective and safe alternative to LIS for the treatment of CAF, with tolerable procedural pain. All patients should be warned of transient incontinence.

Management of chronic fissure in ano-lateral internal sphincterotomy versus 2% diltiazem gel local application: a prospective comparative study

Background: Fissure-in-ano is one of the most common benign anorectal disorders often encountered in surgical outpatient department. Various pharmacological agents and surgical interventions have been tried in the management of fissure in ano. In this study we have compared medical management by topical diltiazem gel with established surgical procedure of lateral internal sphincterotomy (LIS) in the management of chronic anal fissure. Methods: A total of 50 patients with chronic fissure in ano involved in this prospective comparative study, between December 2020 to May 2022, at Rajarajeswari Medical College and Hospital, Bengaluru. Selected patients were put under two groups of 25 participants each, A (2% diltiazem group) and B (lateral internal sphincterotomy - LIS group) using simple randomization technique and were to receive treatment accordingly. Fissure healing and pain relief were recorded on presentation and during follow up visits. Results: The results were compared weekly for 4 weeks and monthly for 2 consecutive months. Fissure healing and pain relief were recorded. Conclusions: Both 2% diltiazem group and LIS group are equally effective and did not show any difference in pain relief or fissure healing with p value not significant (>0.05).

A review of recent advances in the surgical management of anal fissures

An anal fissure is a rupture or lesion in the anal canal's lining below the mucocutaneous junction or dentate line. It is a painful condition that can last for up to two hours during and after defecation. The present literature review is aimed at outlining the clinical signs and symptoms, etiopathogenesis, clinical evaluation, and surgical management of anal fissures with a brief discussion on laser-assisted surgeries. This literature review has been compiled to revisit the different treatment modalities of anal fissures based on the recent updates in the literature. PubMed and ScienceDirect databases were used for the literature search of this review. Based on the literature review surgical interventions are necessary when the conventional pharmacological treatment fails to cure the disease. There are varying outcomes based on the type of surgery with respect to healing rates, recurrence, and incontinence. However, the outcomes of surgery may vary from patient to patient. Various studies have shown that lateral internal sphincterotomy is currently considered the most effective surgical treatment for anal fissures. Surgeons may choose to use either the closed or open method for this procedure. Using lasers for sphincterotomy can help to minimize bleeding and postoperative pain. Despite numerous clinical practice guidelines and systematic reviews, there is still debate over the ideal anal fissure treatment. Surgical treatments discussed in this review have varying advantages and the surgeon is the right person to decide which procedure is suitable for the patient.

To Investigate the Association between the Extent of Lateral Internal Anal Sphincterotomy and Postoperative Fecal Incontinence in Individuals with Chronic Anal Fissure

Background: The primary objective of this investigation was to evaluate the prevalence of fecal incontinence after surgery in individuals who underwent open lateral internal anal sphincterotomy up to the dentate line compared to those undergoing anal sphincterotomy (open internal) up to the height of the anal fissure. Methodology: This study was randomized and controlled and was carried out in Abbasi Shaheed Hospital, Karachi, at the department of surgery between February 2021 and July 2022. The study enrolled patients who were 15 years or older and presented to the outpatient department with chronic anal fissure, regardless of gender. Patients with concomitant anal disease, those with previous history of anorectal surgery & those with systemic neurological disease leading to fecal incontinence were excluded. Analysis of the collected data was performed using SPSS version 23. For quantitative variables, such as age, standard deviation and mean were calculated. Conversely, the qualitative variables, such as gender, location of anal fissure, Browning and Park's classification of incontinence, and final outcome(i.e. fecal incontinence at 5th postoperative day), were assessed using percentages and frequency. Results: In this study, 198 individuals who are chorincally suffering from anal fissure were identified and divided into two groups, Group A and B, each consisting of 99 patients. Group A underwent an open lateral internal anal sphincterotomy up to the level of the dentate line (referred to as the "dentate line group"), while Group B received an open lateral internal anal sphincterotomy up to the height of the fissure (known as the "height of fissure group").Fecal incontinence was assessed and compared between both groups on 5th postoperative day by using Browning and Park’s classification. The findings of this investigation indicated that open lateral anal sphincterotomy up to the level of the dentate line was associated with an 11.1% incidence of fecal incontinence, while a 3% incidence of fecal incontinence was observed in individuals who underwent anal sphincterotomy (lateral internal) up to the height of the anal fissure. Practical Implication: present study suggests that lateral internal anal sphincterotomy up to the height of anal fissure may be associated with a lower risk of fecal incontinence compared to the dentate line group. Conclusion: The data obtained from this study suggested that open anal sphincterotomy (lateral internal) up to the height of the anal fissure was linked to reduced incidence rates of postoperative fecal incontinence on the fifth day after surgery, as compared to open anal sphincterotomy (lateral internal) up to the level of the dentate line. Therefore, this modification should be used in future regularly in order to reduce this morbidity. Keywords: Fecal incontinence, Chronic Anal Fissure, Sphincterotomy.

Botulinum Injection and Sphincterotomy for Management of Anal Fissure in Terms of Healing of Anal Fissure: A Randomized Controlled Trial

Aim: To compare the efficacy of botulinum injection with lateral internal sphincterotomydone for management of anal fissure in terms of healing of anal fissure Study design: Randomized controlled trail Setting and duration: Department of General Surgery, K.E. Medical University, Lahore from April, 2019 to Oct, 2019 Methodology: All 350(175 cases in each group) cases meeting inclusion criteria were enrolled through department of Surgery KEMU. Patients were randomly allocated in two groups, group A and B by Lottery method. Patients in group ‘A’ received treatment with 0.5 ml (20 units) Botulinum toxin injection on each side of anal fissure in the internal anal sphincters under direct vision and digital examination at 3 or 9 o’clock position in lithotomy position under strict aseptic measures by single expert surgeon having at least five years’ post fellowship experience. Patients in group ‘B’ underwent lateral internal anal sphincterotomy under general anesthesia by single expert surgeon also having at least five years’ post fellowship experience. Patients were discharged on 1st post operation day on oral antibiotics, analgesics, stool softeners and were advised sitz bath. In both groups, patients were followed up for 2 months. Results: The mean age of all patients was 43.09 ± 10.68 years while the mean age in Group-A was 43.17±10.32 years and in Group-B was 43.02±11.06 years. The efficacy in Group-A was seen in 158(90.3%) while the efficacy was seen in 114(65.1%) of Group-B, the efficacy of treatment was higher in group-A when compared with Group-B, p-value < 0.001. Conclusion: Botulinum toxin injection for the treatment of anal fissure has yielded higher rates of healing than lateral internal sphincterotomy. This suggests that botulinum injection could provide temporary relief from sphincter spasm, allowing for faster fissure healing and improved quality of life, with fewer risks of complications. Keywords: Sphincterotomy, anal fissure, healing of anal fissure, rectal pain, anal pain, anal surgery

STUDY ON EFFECTIVENESS OF LATERAL ANAL SPHINCTEROTOMY AS AN OUT PATIENT PROCEDURE USING DIATHERMY UNDER LOCAL ANAESTHESIA FOR CHRONIC ANAL FISSURE

Anal fissure is one of the most common surgical disorders of the anal canal, ranking next to hemorrhoids and chronic constipation. The incidence of anal fissure has been increasing since the last two decades due to irregular foot habits as well as improper modern lifestyle habits. The prevalence of anal fissure in general population is probably much more higher than that is seen in clinical practice. This is because ,most of the patients do not seek medical attention or resort to some form of native treatment. In early stages, it can be managed by increasing intake of dietary fibres, stool softeners and Sitz baths .But chronic fissure in ano needs surgical treatment, as the underlying pathology is increased internal anal sphincter tone. Lateral anal sphincterotomy is the procedure of choice, which is usually performed under regional anaesthesia. This procedure can also be performed under local anaesthesia as a day care procedure with similar results. This study aims to determine the feasibility and efficacy of lateral anal sphincterotomy for chronic anal fissure under local anaesthesia using diathermy as an outpatient procedure.