EARLY OUTCOME OF LASER INTERNAL SPHINCTEROTOMY VERSUSOPEN INTERNAL SPHINCTEROTOMY IN THE TREATMENT OF ANAL FISSURES

2021 ◽  
pp. 55-59
Author(s):  
Rajkumar Verma ◽  
Satyendra Kumar ◽  
Vipin Mishra ◽  
Narendra Kumar
Keyword(s):  
Postoperative Pain ◽  
Hospital Stay ◽  
Pain Score ◽  
Treatment Options ◽  
Lateral Internal Sphincterotomy ◽  
Fissure In Ano ◽  
Early Outcome ◽  
Internal Sphincterotomy ◽  
Group A ◽  
Group B

INTRODUCTION : 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 Internal Spincterotomy (LIS) remains the gold standard of treatment for anal ssure. However we compare Laser lateral internal sphincterotomy with Open lateral internal Sphincterotomy for better postoperative pain relief and lesser hospital stay. AIM: Early outcome of laser lateral internal Sphincterotomy versus open lateral internal sphincterotomy in the treatment of anal ssures. MATERIALS AND METHODS: The study was conducted on 50 cases of Laser lateral internal sphincterotomy compare with 50 cases of Open lateral internal sphincterotomy in Maharani Laxmi Bai Medical College, Jhansi between January 2020 to July 2021. RESULTS:In our study in Group A 6% were in 16-20 years, 52% in 21-30 years, 20% in 31-40 years, 20% in 41-50 years and 2% 51-60% years and Group B 2% in 16-20 years, 34% in 21-30 years, 32% in 31-40 years, 18% 41-50%, 10% in 51-60 and 4% in >60. Group A mean postoperative VAS pain score in 6 hours 5.12±0,328, 12 hours 4.32±0.768, 24 hours 3.74±0.777, 36 hours 2.76±1.379 and 48 hours 2.3±1.418. In Group B mean postoperative VAS pain score in 6 hours 5.2±0.452, 12 hours 2.7±1.741, 24 hours 1.76±1.451, 36 hours 0.58±0.971 and 48 hours 0.28±0.671. Group A 44% presented with Perianal swelling, 42% Prutis Ani and 40% atus incontinence. In Group B 6% presented with amount of blood loss 6%, 18% Perianal swelling, 6% infection, 18% atus incontinence. The mean postoperative pain score was signicantly less in Group B at 12 to 48 hours. Group A mean hospital stay was 5.02±1.237 days and in Group B 2.02±0.141 days. It was signicantly less in Group B. CONCLUSION: Laser lateral Internal Spincterotomy is better than open Lateral Internal Spincterotomy with respect to less postoperative pain and lesser hospital stay and also less postoperative complications in the treatment of anal ssure.

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 Feasibility of local anaesthesia in lateral internal anal sphincterotomy for chronic anal fissure

2018 ◽  
Vol 5 (7) ◽  
pp. 2578
Author(s):  
Bhimanagouda Venkanagouda Goudar ◽  
Eshwar B. Kalburgi ◽  
Yamanur P. Lamani ◽  
Veerabhadra Gowd Y. C.
Keyword(s):  
Hospital Stay ◽  
Local Anaesthesia ◽  
Primary Outcome ◽  
Treatment Options ◽  
Fissure In Ano ◽  
Post Operative Pain ◽  
Group A ◽  
Prospective Comparative Study ◽  
The Common ◽  
Group B

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 Spincterotomy (LAS) remains the gold standard of treatment for Chronic Anal Fissures (CAF).Methods: Prospective comparative study conducted on 90 patients randomly divided into two groups Group A under Local anaesthesia (LA) and Group B under Spinal anaesthesia (SA) respectively. The primary outcome variables studied were postoperative pain, hospital stay, and cost effectiveness.Results: A total of 90 patients randomly divided into 45 patients in each group. There was no statistically difference in the pain at surgery, but post-operative pain was significantly less in LA group at 5th hour, 24 hours after surgery. Hospital stay in LA group is significantly less when compared to SA group (1.92, 3.75 respectively).Conclusions: LAS can be comfortably performed under LA with added advantages.

scholarly journals Comparison of hemorrhoidectomy versus hemorrhoidectomy and internal sphincterotomy in terms of postoperative pain.

2020 ◽  
Vol 27 (04) ◽  
pp. 677-681
Author(s):  
Afiya Zulfikar ◽  
Usman Qureshi ◽  
Muhammad Salman Shafique ◽  
Jahangir Sarwar Khan
Keyword(s):  
Postoperative Pain ◽  
Pain Score ◽  
Controlled Trial ◽  
Control Group ◽  
Chi Square ◽  
Internal Sphincterotomy ◽  
Open Hemorrhoidectomy ◽  
Group A ◽  
The Mean ◽  
Group B

Objectives: To compare open hemorrhoidectomy with internal sphincterotomy versus open hemorrhoidectomy alone in terms of frequency of the postoperative pain. Study Design: Randomized Controlled Trial. Setting: Surgical Unit - I, Holy family Hospital, Rawalpindi. Period: For one year  i.e. from January 2016 to December 2016. Material & Methods: 250 patients were divided in two equal groups by lottery method. The surgical procedure was performed using standard protocols after obtaining written informed consent. Anal dilatation was done  after open hemorrhoidectomy in patients of control group (Group A). In the study group (Group B), the patients were subjected to lateral internal sphincterotomy after completion of classical open hemorrhoidectomy. Postoperative pain score was recorded by using visual analog scale. Difference between both groups for pain was analyzed using chi-square test. Results: There were 68 males and 57 females in Group-A and 61 males and 64 females in Group-B. The mean age of patients in Group-A was 33.10±8.77years and in Group-B was 32.52±9.4years. The mean pain score of patients in Goup-A and Group-B was 2.82±2.51 and 1.59±1.58 respectively (P<0.05). In Group-A, 94 (75.2%) cases had no pain while in Group-B, 116 (92.8%) cases were pain free following the procedure. The difference between both groups was significant i.e. P < 0.05. Conclusion: Open hemorrhoidectomy with internal sphincterotomy is effective in reducing postoperative pain.

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. 

scholarly journals Comparison between intravenous injectable diclofenac and per rectal diclofenac suppository as analgesics in operated per anal and perianal benign pathologies

2019 ◽  
Vol 7 (1) ◽  
pp. 263
Author(s):  
Juthikaa Abhijit Deherkar
Keyword(s):  
Pain Relief ◽  
Hospital Stay ◽  
Pain Score ◽  
Pain Scale ◽  
Group A ◽  
Group B ◽  
At Home

Background: Per anal and perianal surgeries are one of the bread and butter surgeries in a surgeons life, and satisfaction of patient matters a lot. Early miraculous recovery has always been patient’s expectations hence we decided to study standard IV method of diclofenac as analgesic with diclofenac suppository and compared their effects on patients with the help of pain scale of 0 to 10.Methods: 200 common per anal surgeries were considered in the study, and were divided in two groups group A post operatively IV diclofenac was given 12 hourly and in group B cases diclofenac suppository 100 mg was started daily twice and the pain score was noted for a week.Results: Diclofenac suppositories resulted in early pain relief and thus early discharges of these patients. The pain score had decreased to a larger extent by day 3 and was almost negligible by day 5 and a few cases to day 7. The hospital stay reduced as patient could manage suppository at home by themselves. IV site complications like thrombophlebitis leading to pain and fever could be easily avoided.Conclusions: Thus diclofenac suppositories proved to be an effective way to give a pain free satisfaction compared to intravenous painful analgesics, thus decreased their hospital stay and also it was a patient friendly.

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 Postoperative recovery; Stapled Hemorrhoidopexy versus Conventional haemorrhoidectomy.

2020 ◽  
Vol 27 (01) ◽  
pp. 166-171
Author(s):  
Ashar Ahmad Khan ◽  
Tania Mahar ◽  
Muhammad Kashif Adnan ◽  
Abdul Rasheed Surahio ◽  
Abdul Manan ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Hospital Stay ◽  
Postoperative Recovery ◽  
Stapled Hemorrhoidopexy ◽  
Anal Stenosis ◽  
P Value ◽  
Group A ◽  
Conventional Haemorrhoidectomy ◽  
Group B

Conventional haemorrhoidectomy, a usual procedure for hemorrhoids in our set up have many short and long term complications. Some patients complained pain many weeks after surgery and are unable to do their routine work. Anal stenosis and recurrence are long term issues. There is need for some other procedure which can decrease postoperative pain and hospital stay. Objectives: To compare the postoperative recovery between stapled hemorrhoidopexy and conventional hemorrhoidectomy. Study Design: Randomized Clinical trial. Setting: Surgery Department of Nishtar Medical University Multan. Period: from 01-01-2018 to 31-12-2018. Material & Methods: Randomly 02 equal groups of the patients, A and B were made. Stapled hemorrhoidopexy (SH) and conventional haemorrhoidectomy was done in group A and B respectively. SPSS version 20 used for data analysis. Mean and standard deviation were used for quantitative variables including postoperative pain, age and hospital stay. Independent Student t test used for comparison of hospital stay and postoperative pain. Effect modifier including gender, age, duration and grade of hemorrhoids were controlled by stratification and Chi square test was applied. P value less than 0.05 was taken as significant. Results: Out of 60 patients, 32 were males and 28 females. In Group A (Stapled Hemorrhoidopexy), mean age was 37.37 + 6.36 years and 39.17 + 5.53 years in Group-B. Postoperative pain in Group A was 3.60 + 1.27 and 6.03 + 1.73 in Group B. Postoperative pain was significantly high in Group B (CH) and P value =0.000. Mean hospital stay was 0.90 + 0.48 days in Group A and 1.87 + 0.57 days in Group B with P value= 0.000. Conclusion: Stapled hemorrhoidopexy is associated with shorter hospital stay and decrease postoperative pain irrespective of age, sex and grade of the hemorrhoids.

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 Outcome of thyroid lobectomies undergone with and without drains

2020 ◽  
Vol 8 (8) ◽  
pp. 2919
Author(s):  
Sahrish Bachani ◽  
Shahid N. Memon ◽  
Muhammad R. Pathan ◽  
Rehmat Sehrish Shah ◽  
Aneeta Kumari ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Wound Infection ◽  
Pain Score ◽  
Thyroid Nodules ◽  
University Hospital ◽  
P Value ◽  
Thyroid Lobectomy ◽  
Significant Difference ◽  
Group A ◽  
Group B

Background: Thyroid lobectomy is a common operative technique of management of benign solitary thyroid nodules in which drains are used routinely. Objective of this study to compare the outcome of thyroid lobectomies undergone with and without drains in patients of benign solitary thyroid nodules.Methods: A comparative cross-sectional research was completed on 98 patients of benign solitary thyroid nodules at surgery department of Liaquat University Hospital Jamshoro. Patients having age of 18-60 years underwent thyroid lobectomies were included and distributed in two groups A and B. Group A includes thyroid lobectomies with drain and Group B without drain. Postoperative outcomes including pain score assessed via visual analog score (VAS), hospital stay and complications including wound infection, seroma and hematoma.Results: Out of 98 cases, 49 underwent thyroid lobectomy with drain and 49 without a drain. Females patients were in majority in group A 42 (85.7%) and also in group B 47 (95.9%). No significant difference (p-value=0.674) was in mean age of group A 30.8±10.2 years and group B 31.8±12.2 years. Higher mean with significant difference (p-value=0.001) was in pain score of group A 5.61±1.25 as compared to group B 3.55±0.70. No significant difference was in complications; seroma 1 (2.04%) vs 5 (10.20%), hematoma 1 (2.04%) vs 1 (2.04%) and infection 3 (6.12%) vs 0 (0.0%) in group A and B respectively. Higher mean with significant difference (p-value=0.001) was in hospital stay of group A 2.40±1.57 days as compared to group B 1.42±0.54 days. No significant difference (p-value=0.748) was in overall rate of complications in group A 5 (10.20%) and B 6 (12.24%).Conclusions: Thyroid lobectomy with drain is not effective in lowering the postoperative complications whereas enhanced the risk of postoperative pain, wound infection and duration of hospital stay as compared to thyroid lobectomy without a drain.

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.

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