Attitudes to the treatment of chronic anal fissure in ano after failed medical treatment

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.

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Comparative study of lateral Internal Sphincterotomy verses Topical Glyceryl Trinitrate for treatment of fissure-in-Ano

Annals of King Edward Medical University ◽

10.21649/akemu.v9i4.1366 ◽

2016 ◽

Vol 9 (4) ◽

Author(s):

Ajmal Farooq ◽

Zahid Niaz

Keyword(s):

Anal Fissure ◽

Chronic Anal Fissure ◽

Symptomatic Improvement ◽

Lateral Internal Sphincterotomy ◽

Fissure In Ano ◽

Internal Sphincterotomy ◽

Group A ◽

Topical Glyceryl Trinitrate ◽

Group B

This prospective randomized interventional study was carried in one of surgical unit of Lahore General Hospital Lahore from 1st January 2002 to 30, December 2002 a total number of 100 patients with both acute and chronic anal fissure were taken and randomly divided in two groups. Group A was treated with 0.2% GTN for 6 weeks and Group B was treated with lateral internal closed Sphincterotomy a follow up after 0, 2nd, 61h weeks and even after 6 months carried out. Peak incidence of disease was observed between 30 and 40 years of age with 56 males and 44 females. 24% patients were with acute fissure and 76% with chronic fissure. In this study with 0.2% GTN overall healing rate of 66.66% for acute fissure and 63.15% for chronic anal fissure was observed. GTN was found less effective in healing the fissure but some what good for initial symptomatic improvement in its comparison 100% healing was observed with lateral internal sphincterotomy with only 10% transient incontinence for flatus. So it was concluded that lateral internal sphincterotomy is superior to GTN and is the procedure of choice for fissure in ano.

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Results of tailored lateral sphincterotomy for chronic fissure in-ano

International Surgery Journal ◽

10.18203/2349-2902.isj20195101 ◽

2019 ◽

Vol 6 (11) ◽

pp. 3947

Author(s):

Ahemadi Firdous Nikhat ◽

Mohd Zaheeruddin Ather

Keyword(s):

Anal Fissure ◽

Gold Standard ◽

Chronic Anal Fissure ◽

Internal Sphincter ◽

Treatment Options ◽

Lateral Internal Sphincterotomy ◽

Fissure In Ano ◽

Lateral Sphincterotomy ◽

Internal Sphincterotomy

Background: Fissure-in-ano is one of the common and most painful anorectal conditions encountered in surgical practice. Inspite of several conservative treatment options, surgical treatment in the form of lateral anal sphincterotomy remains the gold standard of treatment for chronic anal fissure, however it is associated with the significant rate of incontinence. This study reviews using a tailored lateral sphincterotomy by selecting the height of internal sphincter to be divided with aim of preserving more sphincter and hence reducing the incontinence rates.Methods: The study was carried out in 50 patients who were diagnosed clinically as chronic anal fissure attending Surgery department of ESIC medical college and hospital, Kalburagi over a period of 6 months from January 2019 to August 2019. Tailored left lateral internal sphincterotomy was performed in all patients. The date was recorded and analysed. Early post-operative follow-up was maintained every week for four weeks or till the fissure healed. Complications mainly incontinence rate was assessed.Results: Common age group was third and fourth decade of life. Pain (100%) was the commonest symptom. Majority of the patients (96%) had posterior fissure. Postoperatively about 97% patients had complete pain relief. Only one patient (2%) in the study reported incontinence to flatus during the first follow-up visit and had minor incontinence and other minimal complications were found.Conclusions: Tailored lateral anal internal sphincterotomy is safe and effective surgical procedure for the management for chronic anal fissure with lower rate of incontinence rate compared to gold standard lateral internal sphincterotomy.

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A RETROSPECTIVE EVALUATION ON THE SURGICAL MANAGEMENT OF CHRONIC ANAL FISSURE WITH DIFFERENT METHODS OF ANAESTHESIA

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v3i12.832 ◽

2019 ◽

Vol 3 (12) ◽

Author(s):

Subhash Chander Grover

Keyword(s):

Retrospective Study ◽

Anal Fissure ◽

Spinal Anaesthesia ◽

Local Anaesthesia ◽

Chronic Anal Fissure ◽

Age Groups ◽

Cost Benefit ◽

Fissure In Ano ◽

Anal Fissures ◽

Significant Difference

Introduction: Fissure-in-Ano or Chronic Anal Fissures (CAF) is a linear ulcer in the squamous epithelium of the anus, distal to the dentate line & one of the most common and painful anorectal conditions encountered in surgical practice. Surgeons working in a rural setups and First Referral Units are faced with several challenges and limitations. Patients undergoing surgery under spinal anaesthesia have to undergo a battery of blood tests and imaging as a result for poorer patients the cost of treatment becomes manifold. This retrospective study was aimed to compare the outcome of lateral anal sphincterotomy (LAS) for chronic anal fissure, done under Spinal Anaesthesia and Local Anaesthesia. Methods: This Retrospective study involved Prior Consent from the Hospital Authorities & was found to be within ethical standards. Data of 200 patients were selected which were proven cases of Chronic Anal Fissures admitted to the local surgical units in last 4 years. Subjects included both the genders, all age groups including pediatric and geriatric age group and all classes of socio economic strata. Results: Data of total 200 patients were obtained, out of 200 participated 127 were women and 73 were men. A total of 100 patients (50%) underwent LAS under local anaesthesia and 100 patients (50%) underwent LAS under spinal anaesthesia. The mean age of the patients was 41.37 years with Standard Deviation of 3.42 years. There was No Statistical Difference between the two groups in terms of Intraoperative and Postoperative Complication like Pain, Incontinence & Infection after follow up. Conclusion: Lateral anal sphincterotomy (LAS) provides very good healing of Chronic Anal Fissure. Few distinct advantages were noted in the study while doing LAS under LA. It provides adequate pain relief for the procedure apart from the advantage of easy palpability of the sphincter. It can be done as an Outpatient procedure without the need for an anesthetist, and carries a significant cost benefit to the patient especially in lower socio-economic settings. There is no significant difference in the complications or the healing of the fissure when compared with SA. Keyword: Fissure-in-Ano , Lateral anal sphincterotomy, Spinal Anaesthesia , Local Anaesthesia , Retrospective Study.

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