Efficacy of Lateral Internal Sphincterotomy in Treating Chronic Anal Fissure

Abstract

Aim of the study: To determine the effectiveness of lateral internal sphincterotomy in the treatment of chronic anal fissures resistant to pharmacological treatment (chemical sphincterotomy) in terms of recovery time, frequency of recurrences and complications. Study design: This was a prospective descriptive study. Place and duration:In the Department of Surgery,Lahore General Hospital, Lahore during the time period fromJanuary 2021 to August 2021. Material and methods: The study included 80 patients with chronic anal fissure, regardless of age and sex, after the history and clinical examination. All these patients were operated on under general or spinal anesthesia after obtaining consent and routine examinations. Lateral internal sphincterotomy was performed and patients with OPD were followed for 6 to 8 weeks to determine the benefit of the procedure. Results: The study included 57 men and 23 women (M: F ratio 2.2: 1) with a history of pain, bleeding, discharge with or without sentinel tagduring defecation. The average age was 36 and ranged from 20 to 55. The fissure was found in the majority of patients at 6 O clock position (91.2% for men and 52.2% for women). The duration of symptoms was longer in women due to social problems. LIS was used in all patients. Patients were followed in OPD at weeks 1, 2, 4 and 6. Most of the patients fully recovered after 4 weeks. Occasional constipation occurred in 31 (54.4%) men and 11 (47.8%) women. The study found crater ulcers in all 80 patients. All patients had a history of painful bowel movements (100%), but 24 men (42.1%) and 12 women (52.2%) had bleeding and discharge. In 51 male patients (89.5%), the fissure was in the posterior and anterior midline in 3 patients (13.1%). Half of the patients had anterior fissure and the other half had posterior fissures. The sentinel tag was observed in 46 (80.7%) men and 17 (73.9%) women. 11 (19.3%) men and 6 (26.1%) women reported liquid stool incontinence, while 15 men (26.3%) and 9 women (16.9%) reported flatus incontinence. No relapse was observed in all patients after 4 months. Conclusion: As long as the patient is willing to accept the risk of transient fecal incontinence, we can accept the Gold Standard of Treatment (LIS) as first-line therapy for chronic anal fissure. Keywords: Lateral internal sphincterotomy, Chronic anal fissure, Fecal incontinence.