A comparative study of the results of the lateral internal anal sphincterotomy vs manual dilatation of anus for chronic anal fissure.

Objectives: To compare the results of surgical treatment of chronic anal fissure after lateral internal sphincterotomy with manual dilatation of anus. Study Design: Randomized Controlled Prospective study. Setting: Department of Surgery District Teaching Hospital Sargodha, Pakistan. Period: April 2018 to Feb 2019. Material & Methods: Patients were divided into two groups by lottery method. The procedures were performed using standard protocols after obtaining written informed consent. 50 patients underwent lateral internal anal sphincterotomy (Group 1) and 50 patients manual dilatation of anus (Group 2). Patients having atypical anal fissures associated with other diseases were excluded from this study. We assessed both groups for persistence of symptoms, complications and better satisfaction in terms of surgical techniques. Results: All patients became symptoms free within 07-14 days of surgery. Urinary retention was noted in 2(4%) patients in lateral internal sphincterotomy and 2(4%) in manual dilatation of anus. Temporary flatus Incontinence was noted in 2(4%) patient of lateral internal sphincterotomy and 2(4%) in manual dilatation of anus. Faecal soiling was observed in 1(2%) patient of lateral internal sphincterotomy. No recurrence, anal stenosis, hemorrhage, infection of wound, pain and bleeding associated with defecation was seen in both groups. Conclusion: Both lateral internal sphincterotomy and manual dilatation of anus techniques are effective.

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A prospective, randomize study of comparison of lateral internal sphincterotomy versus Lord’s anal dilatation in chronic anal fissure

International Surgery Journal ◽

10.18203/2349-2902.isj20180824 ◽

2018 ◽

Vol 5 (3) ◽

pp. 1026

Author(s):

Dhiraj Kumar ◽

Anil Negi ◽

Neeraj Kumar ◽

Avinash Pandey

Keyword(s):

Anal Fissure ◽

Chronic Anal Fissure ◽

Tertiary Care ◽

Surgical Techniques ◽

Recurrence Risk ◽

Lateral Internal Sphincterotomy ◽

Care Hospital ◽

Anal Dilatation ◽

Female Ratio ◽

Internal Sphincterotomy

Background: Surgical techniques for management of chronic anal fissure are Lords anal dilatation (LAD) and Lateral internal sphincterotomy (LIS). The aim of this study is to compare the symptoms, post-operative complications and recurrence risk of the above two techniques.Methods: It was a prospective, randomized controlled trial done in department of General Surgery of a tertiary care hospital from June 2016-May 2017. A total of 100 patients lined up for surgical management of CAF were divided into two groups (50 each). In group A, 50 patients underwent LAD and in group B, 50 underwent LIS. Patients were followed up for 6 months following surgery for pain, bleeding, incontinence, post-operative hospital stay and recurrence. Wong Baker scale, Modified Longo score and Wexner scales were used for assessment of pain, constipation and incontinence respectively. Various post-operative symptoms, complications and recurrence risk were evaluated post operatively at 24 hours, before discharge from the hospital, 1st, 3rd and 6th months of operation respectively.Results: Male female ratio was 1.7:1. Most common presenting complaint was pain seen in 96% patients. Sentinel tag at 6 o’clock position was seen in the majority (93%) patients on presentation. Except for pain score, which was statistically more significant at 24 hours postoperatively in the LAD group (p=0.012), there was no statistical difference between the two groups when compared at different points of evaluation for symptoms, complications and recurrence (p=0.565).Conclusions: With minor difference in pain, Lord’s dilatation has similar post-operative symptoms; complications and recurrence risk when compared with lateral internal sphincterotomy procedure, for management of CAF and can be safely performed.

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Clinical Outcomes of Lateral Internal Sphincterotomy for Patients with Chronic Anal Fissure

Journal of the Korean Society of Coloproctology ◽

10.3393/jksc.2007.23.5.292 ◽

2007 ◽

Vol 23 (5) ◽

pp. 292

Author(s):

Jung Soo Park ◽

Jae Bum Lee ◽

Tae Sun Kim ◽

Hang Jun Cho ◽

Do Sun Kim ◽

...

Keyword(s):

Clinical Outcomes ◽

Anal Fissure ◽

Chronic Anal Fissure ◽

Lateral Internal Sphincterotomy ◽

Internal Sphincterotomy

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Calibrated lateral internal sphincterotomy for chronic anal fissure

Techniques in Coloproctology ◽

10.1007/s10151-005-0210-9 ◽

2005 ◽

Vol 9 (2) ◽

pp. 127-132 ◽

Cited By ~ 23

Author(s):

G. Rosa ◽

P. Lolli ◽

D. Piccinelli ◽

F. Mazzola ◽

C. Zugni ◽

...

Keyword(s):

Anal Fissure ◽

Chronic Anal Fissure ◽

Lateral Internal Sphincterotomy ◽

Internal Sphincterotomy

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Stellungnahme zum Kommentar von B. Strittmatter zu P.J. Gupta et al. Closed Lateral Internal Sphincterotomy Versus Anal Sphincterolysis for Chronic Anal Fissure. A Prospective, Randomized, Controlled Trial

coloproctology ◽

10.1007/s00053-008-8044-3 ◽

2008 ◽

Vol 30 (6) ◽

pp. 417-417

Author(s):

Pravin J. Gupta

Keyword(s):

Randomized Controlled Trial ◽

Anal Fissure ◽

Chronic Anal Fissure ◽

Controlled Trial ◽

Lateral Internal Sphincterotomy ◽

Internal Sphincterotomy ◽

Randomized Controlled ◽

Prospective Randomized Controlled Trial

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Botulinum Toxin Injection Versus Lateral Internal Sphincterotomy in the Treatment of Chronic Anal Fissure: A Randomized Controlled Trial

World Journal of Surgery ◽

10.1007/s00268-010-0736-5 ◽

2010 ◽

Vol 34 (11) ◽

pp. 2730-2734 ◽

Cited By ~ 28

Author(s):

Maged Nasr ◽

Hussin Ezzat ◽

Magdy Elsebae

Keyword(s):

Randomized Controlled Trial ◽

Botulinum Toxin ◽

Anal Fissure ◽

Chronic Anal Fissure ◽

Controlled Trial ◽

Botulinum Toxin Injection ◽

Lateral Internal Sphincterotomy ◽

Internal Sphincterotomy ◽

Randomized Controlled

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

Annals of King Edward Medical University ◽

10.21649/akemu.v10i1.1133 ◽

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.

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

BIRDEM Medical Journal ◽

10.3329/birdem.v8i3.38130 ◽

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

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

The American Surgeon ◽

10.1177/000313480907501013 ◽

2009 ◽

Vol 75 (10) ◽

pp. 925-928 ◽

Cited By ~ 4

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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