Comparative study of manual anal dilatation and lateral internal anal sphincterotomy in the treatment of acute anal fissure

Abstract

Background: An anal fissure is an extremely common condition which is also one of the most painful condition. It can be very troubling because, if acute, the severity of patient discomfort and extent of disability far exceed that which would be expected from a seemingly trivial lesion. This study compares two most commonly done procedures for anal fissure, manual anal dilatation (MAD) and lateral internal anal sphincterotomy (LAS). Methods: This is a prospective cohort study comparing MAD and LAS in the treatment of chronic anal fissure at Sri Venkateswara Medical College, Tirupati, from December 2017 to December 2018. A total of 60 patients who met inclusion criteria were randomized to undergo either MAD or LAS and analyzed for post-operative pain, postoperative complications, hospital stay, recurrence rates and compliance. Results: Total 60 patients were randomized to MAD and LAS. The patients who have undergone LAS have better pain relief and slightly increased risk of infection. Those who have undergone MAD have less risk of infection and recurrence rates and complications are not significantly less than LAS. Conclusions: MAD and LAS are both equally effective and safe for treatment of acute anal fissure with less chances of recurrence. However postoperative pain was slightly more in MAD group.