Risk of sphincter damage and anal incontinence after anal dilatation for fissure-in-ano

1993 ◽  
Vol 36 (7) ◽  
pp. 677-680 ◽  
Author(s):  
Michael Bachmann Nielsen ◽  
Ole Ø. Rasmussen ◽  
Jan Fog Pedersen ◽  
John Christiansen
Keyword(s):  
Anal Incontinence ◽  
Anal Dilatation ◽  
Fissure In Ano

scholarly journals A comparison of segmental internal sphincterotomy versus lateral internal sphincterotomy in management of chronic fissure in ano

2017 ◽  
Vol 4 (9) ◽  
pp. 3044
Author(s):  
Anil M. Kad ◽  
Murtaza Akhtar ◽  
Rajiv Sonarkar ◽  
Divish Saxena ◽  
Kanav Kumar ◽  
...  
Keyword(s):  
Anal Incontinence ◽  
Internal Sphincter ◽  
Lateral Internal Sphincterotomy ◽  
P Value ◽  
Fissure In Ano ◽  
Lateral Sphincterotomy ◽  
Female Ratio ◽  
Internal Sphincterotomy ◽  
Perianal Sepsis ◽  
Surgical Modality

Background: Fissure in ano is one of the commonest benign and painful proctologic condition encountered in surgical practice treated by conservative line of management. Lateral sphincterotomy is the ideal treatment option for chronic refractory fissure in ano. A newer modality segmental internal sphincterotomy shows good promise in terms of early resolution of symptoms, fissure healing and prevention of anal incontinence involving division of the internal sphincter at two different levels.Methods: In comparative nonrandomized trial patients with chronic fissure in ano satisfying the inclusion and exclusion criteria were allocated to lateral sphincterotomy and segmental internal sphincterotomy groups. The outcome factors were perianal sepsis, pain relief using VAS as assessed on passing the first motion, duration of healing of fissure, assessment of incontinence using Wexner’s continence score on 30th post-operative day.Results: A total of 54 cases were enrolled, of them 31 patients underwent lateral internal sphincterotomy and 23 underwent segmental internal sphincterotomy with the mean age of patient was 34.76 years and a male to female ratio of 1.07:1. The pain score (VAS) on passing stool for the first time postoperatively was 4.5 with lateral sphincterotomy and 3.91 with segmental internal sphincterotomy which was statistically significant (P value < 0.010). The duration of postoperative healing was observed to be 27.94 days and 28.09 days in lateral sphincterotomy and segmental internal sphincterotomy group respectively. The post-operative anal incontinence was evaluated by using Wexner’s continence grading after one month which was not statistically significant between two groups.Conclusions: Segmental internal sphincterotomy could be a good surgical modality with its healing effect on fissure in ano and post-operative complications which are similar to standard lateral internal sphincterotomy.

scholarly journals Lateral internal sphincterotomy V/S anal dilatation

2016 ◽  
Vol 10 (1) ◽  
Author(s):  
Farogh Zahra ◽  
Abdul Majid ◽  
Muhammad Waheed ◽  
Shabbir Chohan
Keyword(s):  
Clinical Trial ◽  
Emergency Department ◽  
Lateral Internal Sphincterotomy ◽  
Anal Dilatation ◽  
Fissure In Ano ◽  
Internal Sphincterotomy ◽  
Operative Complications ◽  
Bleeding Per Rectum ◽  
Surgical Unit ◽  
Trial Setting

Objective: To compare the two surgical procedures performed for the treatment of fissure in ano. Design: Clinical trial Setting: Surgical Unit-III, Sir Ganga Ram Hospital, Lahore. Subjects and Methods: Sixty female patients coming to the out door and emergency department of Sir Ganga Ram Hospital, were included in the study. Thirty patients had oper lateral internal sphincterotomy (LIS) and 30 had anal dilatation (AD). Results: LIS was associated with remarkably to incidence of post operative complications. The patients undergoing AD had more pain and bleeding per rectum in the postoperative period. Anal incontinence was seen in 59.6% of patients, prolapse of haemorrhoids in 40% and recurrence in 6,6%) operated for AD, while the corresponding figures for LIS were 6.6%, 10% & 0% respectively (p<0.05). Conclusion: LIS is a superior procedure to AD for the surgical treatment of fissure in ano. LIS should be adopted as a procedure of choice in uncomplicated fissure in ano.

scholarly journals Efficacy of chemical sphincterotomy with 2% diltiazem cream vs. surgical sphincterotomy in the management of chronic fissure in ano: a clinical study

2018 ◽  
Vol 5 (12) ◽  
pp. 4047
Author(s):  
Jeevan Kenche ◽  
Chandrashekhar Reddy
Keyword(s):  
Anal Incontinence ◽  
Alternative Methods ◽  
Outpatient Basis ◽  
Fissure In Ano ◽  
Duration Of Symptoms ◽  
Chemical Sphincterotomy ◽  
Group I ◽  
Significant Difference ◽  
Flatus Incontinence

Background: Surgical intervention like lateral internal sphincterotomy is very effective and in a time of few weeks, healing can occur but there is danger of the anal incontinence. Hence alternative methods were sought like 2% diltiazem and other agents and they have been shown to lead to proper healing without anal incontinence. The objective was to study efficacy of chemical sphincterotomy with 2% diltiazem cream vs. surgical sphincterotomy in the management of chronic fissure in ano.Methods: A hospital based follow up study was carried out among 60 patients with chronic fissure in ano. They were randomly assigned in two groups. Group I consisted 30 patients who were treated with 2% diltiazem cream on outpatient basis. Group II patients i.e. 30 patients were operated for sphincterotomy. Both the group patients were followed for six weeks at two weeks interval. Outcome like complete healing, fecal incontinence, flatus incontinence was seen at follow up. Chi square test and t test were used to determine the significant difference between the groups.Results: Both the groups were comparable to each other in terms of age, sex, presenting symptoms, mean duration of symptoms and internal findings. Diltiazem group patients had significantly much better healing rate i.e. 96.7% compared to only 80% from patients with   surgery group. Incidence of complications like fecal/flatus incontinence was zero in diltiazem group compared to 13.3%/20% in surgery group.Conclusions: Authors conclude that diltiazem 2% topical application is better than surgical sphincterotomy and should be used instead of surgery.

scholarly journals Graded therapeutic approach to fissure in ano: study of 50 cases

2019 ◽  
Vol 6 (11) ◽  
pp. 3951
Author(s):  
Ketan Vagholkar
Keyword(s):  
Conservative Treatment ◽  
Daily Living ◽  
Age Groups ◽  
Positive Outcome ◽  
Surgical Approaches ◽  
Multimodal Approach ◽  
Anal Dilatation ◽  
Fissure In Ano ◽  
Therapeutic Algorithm ◽  
Single Modality

Background: Fissure in ano is one of the commonest disease affecting all age groups. The condition is quite painful leading to interference in activities of daily living. A wide variety of modalities ranging from medical to surgical approaches have been proposed. However no single modality can be called the gold standard of treatment. Hence the need to develop an optimum graded approach to manage the condition.Methods: Fifty consecutive cases of fissure in ano presenting in an acute state were studied prospectively to develop a therapeutic algorithm for rational treatment of the painful condition.Results: Conservative treatment was commenced in all cases. Eighteen required anal dilatation while out of these eighteen patients, ten required sphincterotomy despite anal dilatation. Four patients had recurrence of symptoms despite all surgical treatments.Conclusions: Conservative treatment still has a significant and positive outcome in fissure in ano. Anal dilatation and sphincterotomy are the next options of treatment. Therefore a graded multimodal approach is therapeutic in treating fissure in ano.

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