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 Results of tailored lateral sphincterotomy for chronic fissure in-ano

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.

scholarly journals A Comparative Study of Efficacy of Outcome of Lateral Internal Sphincterotomy versus Subcutaneous Fissurectomy in Chronic Fissure in Ano

2020 ◽  
Vol 3 (1) ◽  
pp. 59-63
Author(s):  
Suryanaryana Reddy V ◽  
Ravindra Prasad B ◽  
Ram Mohan C ◽  
Vamshi Chandra B ◽  
Satya Dev
Keyword(s):  
Comparative Trial ◽  
Lateral Internal Sphincterotomy ◽  
P Value ◽  
Fissure In Ano ◽  
Painful Condition ◽  
Anal Region ◽  
Internal Sphincterotomy ◽  
Number Of Patients ◽  
Significant Difference ◽  
The Mean

Background: Fissure-in-ano is a very common problem across the world which causes considerable morbidity and affects the patient’s quality of life to a greater extent. Anal fissure is a common painful condition affecting the anal canal. The main aim of study was to compare the efficacy of outcome of subcutaneous fissurectomy versus lateral internal sphincterotomy in chronic fissure in Ano. Subjects and Methods: The study was a prospective, parallel group, comparative trial. The study was conducted at Department of General Surgery, Chalmeda AnandRao Institute of Medical Sciences, Karimnagar. The number of patients included in the study was 50. Patients were divided into lateral internal sphincterotomy groups and subcutaneous fissurectomy groups. Patients were followed up regularly for relief of symptoms i.e., pain in the anal region and bleeding from anal region and for complications like incontinence; duration of sitz baths and number of work days lost. Results: The mean age group in the present study was 38.24  9.96 for subcutaneous fissurectomy and 39.2  10.4 for lateral internal sphincterotomy; there was no significant difference in the mean age in either of the groups with P value > 0.05. Conclusion: The current study shows results in favor of subcutaneous fissurectomy with a healing rate of 100% with faster pain-relief and minimal or no complications if performed by the hands of an experienced surgeon.

scholarly journals Prospective comparative study between lateral sphincterotomy and subcutaneous fissurectomy with topical 2% diltiazem gel in the treatment of chronic fissure in ano

2019 ◽  
Vol 6 (7) ◽  
pp. 2571
Author(s):  
Dhrubajyoti Dey ◽  
Gopinath Pai
Keyword(s):  
Test Group ◽  
Lateral Position ◽  
Lateral Internal Sphincterotomy ◽  
Treatment Modalities ◽  
Control Group ◽  
Fissure In Ano ◽  
Lateral Sphincterotomy ◽  
Internal Sphincterotomy ◽  
Group A ◽  
Group B

Background: Anal fissure is defined as an ulcer in the anoderm usually in the posterior midline, less frequently in the anterior midline and rarely in the lateral position of the anal canal. Different treatment modalities include non-invasive pharmacological therapies, lateral internal sphincterotomy (LIS) which is the gold standard for treatment and new therapies that include perineal support devices, Gonyautoxin injection, fissurectomy, fissurotomy, sphincterolysis, and flap procedures. Thus, aim of the study was to compare the efficacy of outcome of lateral internal sphincterotomy and subcutaneous fissurectomy with topical 2% Diltiazem gel in the treatment of chronic fissure in ano.Methods: 50 patients with chronic fissure in ano attending OPD of Department of General Surgery, KVGMCH, Sullia were randomly selected and divided into Group A (n=25): Lateral internal sphincterotomy (control group) and Group B (n=25): Subcutaneous fissurectomy + topical 2% Diltiazem Gel (test group).Results: Patients of Group B showed much less mean duration of absenteeism (2.88 weeks) compared to Group A. Comparison between Group B and Group A showed statistically significant differences in pain relief (P<0.0001), complications (p=0.03), mean duration of sitz baths (p<0.0001), absenteeism (p<0.0001) respectively.Conclusion: Hence Subcutaneous fissurectomy with topical 2% Diltiazem gel is a better surgical option for chronic fissure in ano than conventional Lateral internal sphincterotomy. 

A PROSPECTIVE STUDY OF OPEN VERSUS CLOSED LATERAL INTERNAL SPHINCTEROTOMY IN CHRONIC ANAL FISSURES

2021 ◽  
pp. 39-40
Author(s):  
Md. Mushir Reyaz ◽  
Kumari Pallavi ◽  
C. M. Narayan ◽  
Debarshi Jana
Keyword(s):  
Prospective Study ◽  
Severe Pain ◽  
Lateral Internal Sphincterotomy ◽  
Fissure In Ano ◽  
Lateral Sphincterotomy ◽  
Internal Sphincterotomy ◽  
Closed Technique ◽  
Operative Complications ◽  
Open Versus ◽  
A Prospective Study

Background: Fissure-in-ano is a very common anal disorder which predominantly presents with severe pain. Lateral internal sphincterotomy remains the main treatment modality. This may be performed using open or closed method, each with their attendant complications. Objective: This prospective study compared the results and complications of open versus closed technique of lateral sphincterotomy in patients with chronic anal ssure. Materials and Methods:Atotal of 64 patients with chronic anal ssure were enrolled in this study. Of these, 34 patients underwent open lateral sphincterotomy, and 30 underwent closed sphincterotomy. They were followed up for 6 months postsurgery. The results and complications of the two groups were compared and statistically analyzed. Results: Post-operative complications such as pain, bleeding, infection, incontinence, and recurrence were compared between the two groups. Pain, bleeding, and incontinence to atus were signicantly lesser in the closed group (P < 0.05), while there was no difference in the incidence of infection and recurrence between the two groups. Conclusion: Closed lateral internal sphincterotomy is a better alternative compared to open sphincterotomy in the treatment of chronic anal ssures.

scholarly journals A Comparison between the Results of Open versus Closed Lateral Internal Sphincterotomy in the Surgical Management of Chronic Anal Fissure

2018 ◽  
Vol 8 (3) ◽  
pp. 235-239
Author(s):  
Md Mahabub ◽  
Md Mahbubur Rahman ◽  
Md Tanvirul Islam ◽  
Selina Sultana
Keyword(s):  
Anal Fissure ◽  
Chronic Anal Fissure ◽  
Lateral Internal Sphincterotomy ◽  
Complication Rates ◽  
Open Technique ◽  
Female Ratio ◽  
Internal Sphincterotomy ◽  
Closed Technique ◽  
Increased Risk ◽  
Open Versus

Background: Lateral internal sphincterotomy is regarded as the gold standard surgical treatment for chronic anal fissure. Some authors reported that the closed technique had lower complication rates than that by the open technique, but others reported that both of the techniques had no meaningful differences in complications.Methods: This was a comparative and cohort study carried out at Department of Colorectal Surgery, Combined Military Hospital (CMH) Dhaka, Bangladesh, from October 2013 to October 2017. Eighty three patients with chronic anal fissure not responding to medical treatment for at least three months were included in this study to compare the results of the open versus closed techniques of lateral internal sphincterotomy after four months follow up postoperatively.Results: The mean age at presentation was 34.15±11.4 years and the male to female ratio was 1.24:1. The results of open and closed techniques were compared regarding per-operative bleeding (35.71% versus 12.19%), post-operative urinary retention (4.76% versus 0%), symptom relief on first post-operative day (76.19% versus 70.73%), significant 1st post-operative day pain in the operated wound (33.33% versus 7.31%), temporary fecal soiling (2.38% versus 0%), temporary flatus incontinence (7.14% versus 0%), and fissure recurrence (0% versus 14.63%) respectively. Temporary incontinence to fecal and flatus recovered by conservative management within two and four months of surgery respectively.Conclusion: The closed technique of lateral internal sphincterotomy had lower post-operative complications, pain, bleeding, and incontinence compared to open technique, but increased risk of fissure recurrence.Birdem Med J 2018; 8(3): 235-239

Botulinum Toxin A with Fissurectomy is a Viable Alternative to Lateral Internal Sphincterotomy for Chronic Anal Fissure

2009 ◽  
Vol 75 (10) ◽  
pp. 925-928 ◽  
Author(s):  
Ohara Aivaz ◽  
Jessica Rayhanabad ◽  
Vincent Nguyen ◽  
Philip I. Haigh ◽  
Maher Abbas
Keyword(s):  
Botulinum Toxin ◽  
Fecal Incontinence ◽  
Anal Fissure ◽  
Chronic Anal Fissure ◽  
Botulinum Toxin A ◽  
Internal Sphincter ◽  
Viable Alternative ◽  
Lateral Internal Sphincterotomy ◽  
Toxin A ◽  
Internal Sphincterotomy

Lateral internal sphincterotomy (LIS) is the gold standard surgical treatment for anal fissure. However, it carries potential complications, including fecal incontinence. The goal of this retrospective study was to compare the outcome of botulinum toxin A injection coupled with fissurectomy ([BTX + FIS) versus LIS. There were 59 patients who underwent BTX + FIS or LIS over a 5-year period. LIS was performed in the standard fashion without fissurectomy. BTX + FIS entailed internal sphincter injection with 80 units of botulinum toxin A coupled with fissurectomy. Forty patients underwent LIS and 19 had BTX + FIS. The choice of operation was based on the patient's preference. Primary healing rate was 90 and 74 per cent in the LIS and BTX + FIS groups, respectively ( P = 0.13). The complication rate was 10 per cent in the LIS vs 0 per cent in the BTX + FIS groups ( P = 0.29). Complications of LIS included anal sepsis in one patient and flatal and/or fecal incontinence in three patients. During a mean follow up of 19 months; recurrence rate was 0 and 5 per cent in the LIS and BTX+FIS groups, respectively ( P = 0.32). The results of this study demonstrate that BTX + FIS is a viable alternative to LIS for patients with chronic anal fissure and should be considered as an alternative first-line surgical therapy.

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