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

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.

A comparative study between lateral internal anal sphincterotomy and botulinum toxin injection in the treatment of chronic anal fissure

Background and objective: The gold standard for the treatment of chronic anal fissure is lateral internal sphincterotomy. Botulinum toxin injection provides temporary alleviation of sphincter spasm and allows the fissure to heal. This study aimed to compare the outcomes of lateral internal sphincterotomy and botulinum toxin injection treatments in patients with uncomplicated chronic anal fissure. Methods: A prospective comparative study was carried out at the surgical unit of Erbil teaching hospital, Erbil, Kurdistan Region of Iraq, from January 2017 to February 2018. Fifty-five patients were enrolled in this study. Five patients were excluded, and the remaining 50 patients were equally divided into two groups. Group A was managed with lateral internal sphincterotomy and group B with botulinum toxin. Postoperative pain relief, bleeding, fissure healing, incontinence, and relapse after six weeks and three months of follow-up were compared. Results: One month after treatment, 12% of the lateral internal sphincterotomy group had bleeding, while none of the botulinum toxin group (P = 0.234). Two patients (8%) of the lateral internal sphincterotomy group had pain while one (4%) of the botulinum toxin group (P >0.999).Three months after treatment, 4% of the lateral internal sphincterotomy group had bleeding, while none of the botulinum toxin group (P >0.999). None of the lateral internal sphincterotomy group had pain while one (4%) of the botulinum toxin group (P >0.999). Regarding healing, 96% of the lateral internal sphincterotomy group healed, while 92% in the botulinum toxin group (P >0.999). Conclusion: The outcome of lateral internal sphincterotomy and botulinum toxin were nearly the same, but lateral internal sphincterotomy required hospitalization, period off work, and risk of anesthesia. These risks were absent in botulinum toxin injection. Keywords: Chronic anal fissure; Lateral internal sphincterotomy; Botulinum toxin; Complications.

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

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.