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

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

International Surgery Journal ◽

10.18203/2349-2902.isj20170861 ◽

2017 ◽

Vol 4 (3) ◽

pp. 1055 ◽

Cited By ~ 1

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.

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Comparison of Open Versus Closed Lateral Internal Sphincterotomy in the Management of Chronic Anal Fissure

Hellenic Journal of Surgery ◽

10.1007/s13126-019-0512-4 ◽

2019 ◽

Vol 91 (2) ◽

pp. 91-95

Author(s):

Hareesh Mahabala Mukri ◽

Neeti Kapur ◽

Vishesh Guglani

Keyword(s):

Anal Fissure ◽

Chronic Anal Fissure ◽

Lateral Internal Sphincterotomy ◽

Internal Sphincterotomy ◽

Open Versus

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Lateral Internal Sphincterotomy for Treatment of Chronic anal Fissure in Paediatrics

Journal of Pediatrics & Neonatal Biology ◽

10.33140/jpnb.03.02.4 ◽

2018 ◽

Vol 3 (2) ◽

Keyword(s):

Surgical Technique ◽

Conservative Treatment ◽

Anal Fissure ◽

Chronic Anal Fissure ◽

Postoperative Bleeding ◽

Lateral Internal Sphincterotomy ◽

Open Technique ◽

Internal Sphincterotomy ◽

History Of ◽

A Prospective Study

Aims: Lateral internal sphincterotomy is a well established surgical technique for treatment of chronic anal fissure in adult. We performed this study to evaluate the outcome of lateral internal sphincterotomy in Paediatrics. Patients and Methods: This is a prospective study performed over a period of 4 years from October 2008 to October 2012 on 37 patients with chronic anal fissure of a duration exceeding 3 months and history of failure to conservative treatment. All patients underwent left lateral internal sphincterotomy through an open technique. Outcome was evaluated by assessing the effectiveness of this procedure in relieving the symptoms, fissure healing, parents’ satisfaction and complication rate. Results: There were 26 boys and 11 girls, mean age was 11 months with a range of (6 months - 12 years), and symptoms were relieved within 2 weeks in 28 cases and within one month in 5 cases. 4 patients require postoperative oral laxative for 1-3 months to overcome the withholding behavior. Fissures were healed in 34 by 8 weeks postoperatively. Parent satisfied with the outcome in 32 patients. 4 patients developed postoperative bleeding and only one of them was serious and required cauterization, soiling occurred in 3 cases. No permanent incontinence was reported. Conclusion: Lateral internal sphincterotomy is an effective and safe surgical technique for treatment of chronic anal fissure not responding to medical treatment in paediatric. Complications are uncommon and the risk of incontinence is very minimal if proper surgical technique is performed.

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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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Early Outcome of Open versus Closed Lateral Internal Anal Sphincterotomy in the Treatment of Chronic Anal Fissure

Journal of Surgical Sciences ◽

10.3329/jss.v22i1.44027 ◽

2020 ◽

Vol 22 (1) ◽

pp. 52-57

Author(s):

Hasnat Zaman Zim ◽

Debashish Bar ◽

Ashok Kumar Sarker ◽

Salma Sultana

Keyword(s):

Anal Fissure ◽

Chronic Anal Fissure ◽

Lateral Internal Sphincterotomy ◽

Chi Square ◽

Early Outcome ◽

Internal Sphincterotomy ◽

Medical College ◽

Student’S T ◽

Group B ◽

Open Versus

Background: Chronic anal fissure is a benign disorder that is associated with considerable discomfort. Surgical treatment in the form of lateral internal sphincterotomy has long been regarded as the gold standard of treatment. Two methods of sphincterotomy are currently practiced: open or closed technique. Objective: The objective of this study was to compare the early outcome of closed versus open lateral internal anal sphincterotomy for the treatment of chronic anal fissure, based on the assessment of post-operative pain and complications. Methods: A comparative study was conducted at the department of surgery in Dhaka Medical College & Hospital, over a period of 6 months from April 2015 to September 2015. A total of 80 patients were purposefully included in this study and were equally divided into two groups; Group A included 40 patients undergone closed lateral internal anal sphincterotomy and Group B included 40 patients undergone open lateral internal anal sphincterotomy. Patients were followed up postoperatively for 6 weeks to assess any complications. The outcomes were compared between the groups using the Chi-square (x2) test and Student's "t" test. Results: Delayed postoperative healing was found in 7.5% patients of the open lateral internal anal sphincterotomy group. The mean pain score and duration of hospital stay were lower in closed lateral internal anal sphincterotomy group. Conclusion: Closed lateral internal sphincterotomy is preferred to open technique in the treatment of chronic anal fissure, as it is effective, safe, less expensive, and is associated with low complication rate. Journal of Surgical Sciences (2018) Vol. 22 (1): 52-57

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