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

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.

scholarly journals Prospective Randomized Study between Open Vs Closed Lateral Anal Internal Sphincterotomy in Patients with Chronic Fissure in Ano

2020 ◽  
Vol 3 (1) ◽  
pp. 167-171
Author(s):  
Anand Shanmugaiah ◽  
Saravanan Pandian
Keyword(s):  
Anal Fissure ◽  
Chronic Anal Fissure ◽  
Randomized Study ◽  
Fissure In Ano ◽  
Internal Sphincterotomy ◽  
Post Surgery ◽  
Significant Difference ◽  
Group A ◽  
Group B

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.

scholarly journals Closed versus open lateral internal anal sphincterotomy in a chronic anal fissure

2017 ◽  
Vol 4 (3) ◽  
pp. 1055 ◽  
Author(s):  
Anandaravi B. N. ◽  
Ramaswami B.
Keyword(s):  
Anal Fissure ◽  
Recurrence Rate ◽  
Chronic Anal Fissure ◽  
Randomized Study ◽  
Lateral Internal Sphincterotomy ◽  
Internal Sphincterotomy ◽  
Closed Technique ◽  
Significant Difference ◽  
Group A ◽  
Group B

Background: Anal fissure is a common proctological problem, which presents with pain in the anal region during and after defecation. The aim of the study was to determine the best technique for surgical treatment of chronic anal fissure patients.Methods: The study was designed as a prospective randomized study. The study was conducted in surgical unit, K.R. Hospital, MMCRI, Mysore, India from January 2015 to June 2016. A total of 100 patients undergoing surgery were divided into two groups. In group A there were 50 patients who were treated by closed lateral internal anal sphincterotomy, and in group B there were 50 patients who were managed by open lateral internal anal sphincterotomy method. Patients were followed up for 6 months following surgery to observe for pain, bleeding, infection, incontinence, and recurrence. The exclusion criteria were patients who had in addition haemorrhoids or any other anorectal diseases.Results: There was acceptable difference in postoperative acute complications between the two methods of internal anal sphincterotomy. However, in group A, three patients (6%) versus 10 (20%) were complicated with incontinence postoperatively, whereas the recurrence rate was 4 versus 4% in group A versus group B, respectively (P = 0.015).Conclusions: There was significant difference between closed and open methods of lateral internal sphincterotomy in recurrence rate, healing rate, and other complications. Closed lateral internal sphincterotomy is treatment of choice for chronic anal fissure and can be done effectively and safely with acceptable rate of complications. Our recommendations are that closed technique should be adopted by experienced surgeons and Trainee should be initially trained by open technique then be shifted to closed technique.

scholarly journals Comparative study of closed versus open lateral internal sphincterotomy in the management of chronic anal fissure

2020 ◽  
Vol 7 (4) ◽  
pp. 1158
Author(s):  
Anand R. Bansal ◽  
Manish Bansal ◽  
Ankit Bhardwaj
Keyword(s):  
Anal Fissure ◽  
Chronic Anal Fissure ◽  
Anal Verge ◽  
Dentate Line ◽  
Lateral Internal Sphincterotomy ◽  
Internal Sphincterotomy ◽  
Significant Difference ◽  
Delayed Healing ◽  
Group A ◽  
Group B

Background: Anal fissure is a painful tear in distal anal canal extending from just below the dentate line to anal verge. Patient presents with pain during or after defecation and passage of bright red blood per anus. Various studies investigating chronic anal fissures show a large variation in healing rates for different modalities. The present study was carried out to evaluate effectiveness of closed versus open lateral internal sphincterotomy in treatment of patients with chronic anal fissure.Methods: A prospective study was conducted in the Department of Surgery, Pt. B.D. Sharma PGIMS, Rohtak. Group A and group B included 20 patients each with chronic anal fissure and managed by closed and open lateral internal sphincterotomy respectively and effectiveness was evaluated with regards to fissure healing, pain reduction, recurrence and incontinence after surgical treatment.Results: The mean pain scores on visual analogue scale at end of 1 week in group A and group B was not found to be statistically significant, whereas it was found to be statistically significant at 3 week and at 6 weeks. Delayed healing was seen in 1 patient of group B, whereas no patient in group A had delayed healing or absence of healing postoperatively.Conclusions:There was a significant difference between closed and open methods of lateral internal sphincterotomy in terms of relief in post-operative pain but as a whole both techniques did not show any statistically significant difference in terms of fissure healing, postoperative complications or recurrence at 3 months.  

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 Comparison of Fissurectomy and Lateral Internal Sphincterotomy in the Surgical Management of Chronic Anal Fissure

2021 ◽  
pp. 192-198
Author(s):  
Kazim Ali Memon ◽  
Shahnawaz Khatti ◽  
Ahmed Hussain Pathan ◽  
Shahida Khatoon ◽  
Abdul Salam Memon ◽  
...  
Keyword(s):  
Anal Fissure ◽  
Chronic Anal Fissure ◽  
Controlled Trial ◽  
Lateral Internal Sphincterotomy ◽  
Favorable Result ◽  
Internal Sphincterotomy ◽  
Satisfactory Outcome ◽  
Resting Pressure ◽  
Group A ◽  
Group B

Background: The anal fissure is a small spilt in the distal anoderm, and it most commonly occurs in the posterior midline of anal canal. Anal fissure causes severe sharp pain on defecation, occasionally accompanied by streak of blood on outside of stool or blood on toilet tissue. Fissures are classified as acute or chronic, acute fissure usually heal spontaneously within six weeks. Fissurectomy had been used as separate technique in the treatment of chronic anal fissure with favorable result. Parallel inside sphincterotomy produces an enduring fall of anal resting pressure, that reestablish mucosal perfusion bringing about recuperating, yet genuine drive component is obscure, and the instrument that travel from intense to constant gap stay dark. This study is design to assess the outcome between two groups, than better modality of the two could be chosen. Objective: To compare fissurectomy and lateral internal sphincterotomy in the management of chronic anal fissure. Patient and Methods: The Randomized controlled trial was conducted during 18-02-2015 to 17-08-2015 at Department of surgery,Liaquat University of Medical & Health Sciences, Hyderabad. A total of 218 patients with chronic anal fissure were included in this study. Patients were randomly divided into two groups. Patients in Group A were underwent fissurectomy and patients group B was underwent lateral internal sphincterotomy. Surgery was performed and patients were followed for 8 weeks on regular basis and satisfactory out comes was noted. Information along with demographics was entered in the proforma. Results: Rate of satisfactory outcome was significantly high in group B as compare to group A [92.66% vs. 76.15%; p=0.001]. Conclusion: Subcutaneous sidelong internal sphincterotomy is a significant surgery for patients with persistent anal fissure. It is compelling and safe, offers fast help of torment, and advances early gap mending without being gone to by any significant complexities.

scholarly journals Closed lateral Internal Sphincterotomy under local anesthesia in OPD in the treatment of chronic Anal Fissure

2016 ◽  
Vol 10 (1) ◽  
Author(s):  
Naved Ahmad ◽  
Muzaffar Aziz ◽  
Faizullah .
Keyword(s):  
Postoperative Complications ◽  
Anal Fissure ◽  
Local Anesthesia ◽  
Local Anaesthesia ◽  
Chronic Anal Fissure ◽  
Dentate Line ◽  
Lateral Internal Sphincterotomy ◽  
Internal Sphincterotomy ◽  
Operative Complications

Objective of this study is to provide best therapy in terms of hospital stay and post operative complications after closed lateral internal sphincterotomy under local anaesthesia in the treatment of chronic anal fissure. It is descriptive type of study carried out at Nishtar Hospital Multan, from February 2001 to April 2001. Thirty patients underwent closed lateral internal sphicterotomy in local anaesthesia in OPD. Internal anal sphincter divided up to dentate line by introducing no.11 surgical blade in the intersphicteric groove. Pts were allowed to go home just after the surgery. Follow up for complications was done for the period of 6months. Mean postoperative stay was for 12 minutes. Postoperative complications were soiling (6.6%), incontinence to flatus (3.3%) and recurrence (3.3%). CLIS can be done safely under local anesthesia in OPD with low complication rate and less postop period of stay.

Topical 0.5% nifedipine vs. lateral internal sphincterotomy for the treatment of chronic anal fissure: long-term follow-up

2005 ◽  
Vol 21 (2) ◽  
pp. 179-183 ◽  
Author(s):  
Panagiotis Katsinelos ◽  
Basilios Papaziogas ◽  
Ioannis Koutelidakis ◽  
George Paroutoglou ◽  
Stavros Dimiropoulos ◽  
...  
Keyword(s):  
Anal Fissure ◽  
Chronic Anal Fissure ◽  
Lateral Internal Sphincterotomy ◽  
Internal Sphincterotomy ◽  
Long Term Follow Up

PROSPECTIVE RANDOMIZED STUDY BETWEEN OPEN VS CLOSED LATERAL ANAL INTERNAL SPHINCTEROTOMY IN PATIENTS WITH CHRONIC FISSURE IN ANO AT SKMCH, MUZAFFARPUR, BIHAR

2021 ◽  
pp. 65-66
Author(s):  
Kumar Vikram ◽  
Sanjay Kumar ◽  
Manoj Kumar ◽  
Debarshi Jana
Keyword(s):  
Randomized Study ◽  
Young Patients ◽  
Fissure In Ano ◽  
Common Cause ◽  
Internal Sphincterotomy ◽  
Acute Complications ◽  
Group A ◽  
Group B ◽  
Cause Of Pain

Background: One of the most common cause of pain during defecation in young patients is chronic ssure in ano. Surgical treatment of choice for chronic ssure 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 ssure. Subjects and Methods: 105 patients admitted in department of general surgery with chronic ssure 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. A3 months follow up done in both postsurgery to observe for pain, bleeding, infection, incontinence, and recurrence. Results: Signicant 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 ssure, either open or closed method. However, the closed method was observed to have lesserpost operative complication compared to the open method

scholarly journals Surgical management of anal fissure versus Glyceryl Trinitrate ointment: a comparative prospective study

2018 ◽  
Vol 5 (6) ◽  
pp. 2205
Author(s):  
Sandeep Reddy ◽  
Krishnaprasad . ◽  
Sreeramulu P. N. ◽  
Amal Abraham ◽  
Praveen G. P. ◽  
...  
Keyword(s):  
Prospective Study ◽  
Anal Fissure ◽  
Symptomatic Relief ◽  
High Rate ◽  
Lateral Internal Sphincterotomy ◽  
Nitroglycerin Ointment ◽  
Internal Sphincterotomy ◽  
Skin Tag ◽  
Group A ◽  
Group B

Background: Anal fissure is common condition in general population which cause severe pain at the anal region while defecation and associated with bleeding. These symptoms cause reduction in quality of life with considerable morbidity. The objective of this study was to compare the difference in outcome between open lateral anal sphincterotomy and application of topical 0.2% nitroglycerin ointment for the treatment of chronic anal fissure and their individual efficacy.Methods: 68 cases with a clinical diagnosis of anal fissure were recruited in the study. All selected patients met with inclusion criteria. Thus, selected cases were assigned to one of the other groups by odd and even method. Group A was managed conservatively using topical 0.2% nitroglycerin ointment, whereas Group B underwent open lateral anal sphincterotomy. Both groups were followed up at 3 week, 6 weeks, and 12 weeks, after the treatment.Results: Among all the 68 patients, all patients had come with complaint of pain whereas 31 patients had bleeding per rectum along with pain. On clinical examination, hypertonic anal sphincter elicited in 47 patients, sentinel skin tag was noted in the 23 patients. Group A included 34 patients treated with topical 0.2% nitroglycerin ointment and group B included 34 patients who underwent lateral internal sphincterotomy. In group A, 25 (73.5%) patients treated successfully, 9 (26.4%) patients were uncured who underwent lateral anal sphincterotomy, with no fresh complaints during follow up. By contrast, all patients in group B were successfully treated and only one (0.03%) patient came with unexplained discomfort and one patient suffered from flatus incontinency.Conclusions: This prospective study, demonstrates that open lateral internal sphincterotomy is superior to topical nitroglycerin application in the treatment of anal fissure with good symptomatic relief, high rate of healing with very low rate of early incontinence. Patients who are not willing to undergo surgery the glycerin trinitrate ointment can be used as medical line for fissure in ano.

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