Long-term results of lateral internal sphincterotomy for chronic anal fissure with particular reference to incidence of fecal incontinence

Nyam, D. C. N. K.; Pembérton, John H.

doi:10.1007/bf02234220

Cited by 268 publications

(200 citation statements)

References 19 publications

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“…In our study 3 patients of surgical treatment group had fecal incontinence in first 6 weeks and by the end of 8 weeks only one patient had frank fecal incontinence. In other study there was also occurrence of incontinence in 8 % to 30 % of patients [14,15]. Therefore our present study corroborates well with the standard studies of comparative study of lateral internal sphincterotomy versus 2 % Diltiazem ointment for treatment of chronic anal fissure which is well supported by several literatures.…”

Section: Discussionsupporting

confidence: 92%

Comparative Study of Lateral Sphincterotomy versus Local 2 % Diltiazem Ointment for the Treatment of Chronic Anal Fissure

Kuiri¹,

Saha²,

Ghosh³

et al. 2014

IOSRJDMS

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A chronic anal fissure is a non-healing linear tear in the distal anal mucosa below the dentate line and is a painful entity. A fissure is defined as chronic when it fails to heal within Keywords-Lateral internal sphincterotomy, 2 % Diltiazem ointment, chronic anal fissure. I.INTRODUCTION A chronic anal fissure is a crack in the distal anal mucosa which often does not heal after an acute attack. Apart from it being a painful condition it has different modes of presentation such as bleeding per rectum, pain during defecation and pain during defecation with constipation. There are several factors for the development of chronic anal fissure like internal sphincter hypertonia, trauma due to passage of hard stools or diarrhoea episodes, paucity of blood supply, especially the posterior commissure, by the compression of inferior rectal artery. The paucity of blood flow prevents healing of anal fissure until the cycle of internal sphincter hypertonia and decreased blood flow is broken by muscle relaxants or surgery. There are different non-surgical treatments for chronic anal fissure including 2 % Diltiazem ointment topical application and also there are different surgical interventions including lateral internal sphincterotomy. The study was designed to compare the effect of medical management with topical 2 % Diltiazem ointment and surgical treatment by lateral internal sphincterotomy in case of chronic anal fissure with regards to ulcer healing, pain reduction, cessation of bleeding per rectum and incontinence.

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Section: Discussionsupporting

confidence: 92%

Comparative Study of Lateral Sphincterotomy versus Local 2 % Diltiazem Ointment for the Treatment of Chronic Anal Fissure

Kuiri¹,

Saha²,

Ghosh³

et al. 2014

IOSRJDMS

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“…Although some degree of incontinence during the follow-up occurred in 45% of the patients; most of them were of mild intensity and transient duration. Finally, 95% of the patients were happy with the surgical outcomes 23 . Alper et al 24 evaluated patients submitted to sphincterotomy, hemorrhoidectomy and compared them to patients with regular manometric evaluations.…”

Section: Discussionmentioning

confidence: 91%

“…Only one patient had transient incontinence to flatus, recovering complete continence 8 weeks after the procedure. Fecal incontinence has been described in up to 16% of the patients submitted to LIS 9,27 , being more common in the first 5 weeks with the recovery rate varying in the literature 23 . However, its incidence may alter according to the surgical technique, length of sphincterotomy and follow-up period 20,28 .…”

Section: Discussionmentioning

confidence: 99%

Clinical and manometric evaluation of women with chronic anal fissure before and after internal subcutaneous lateral sphincterotomy

Silva¹,

Rosa²,

Almeida³

et al. 2012

J. Coloproctol. (Rio J.)

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Silva SM, Rosa VF, Almeida RM, Coura MMA, Oliveira PG, Sousa JB. Clinical and manometric evaluation of women with chronic anal fissure before and after internal subcutaneous lateral sphincterotomy. J Coloproctol, 2012;32(2):148-153. ABSTRACT: Objective:To evaluate clinical and manometric parameters of chronic anal fissure females undergoing lateral internal sphincterotomy (LIS). Methods: A total of eight women with chronic anal fissure who underwent LIS were included in this study. The preoperative assessment was performed one week before surgery and included general and anorectal examination, anorectal manometry, and Jorge Wexner questionnaire. The post operative follow up was made every 15 days until complete healing. Jorge Wexner questionnaires and anorectal manometry were repeated at 1 month and 3 months after the surgery. Time to healing, manometric changes and complications were assessed. Results: All patients had preoperative increased anal resting pressure. The resting pressures and anal canal length were significantly decreased 3 months after surgery. Patients' complaints of itching and bleeding were also reduced. Fissures healed in 7 patients and median healing time was 45 days. No complications were observed due to the procedure. One patient had transient incontinence to flatus. Conclusion: Lateral internal sphincterotomy provided clinical improvement and reduced resting pressure of the internal anal sphincter in women with chronic anal fissure.Keywords: anal fissure; anal canal; manometry; wound healing. RESUMO: Objetivo: Avaliar a evolução clínica e manométrica de mulheres com fissura anal crônica submetidas à esfincterotomia lateral interna subcutânea. Métodos: Estudo prospectivo com oito pacientes. A avaliação inicial foi realizada por meio de questionários, exame fí-sico e manometria anorretal na semana anterior ao procedimento cirúrgico. Durante o período pós-operatório, as pacientes foram avaliadas clinicamente a cada 15 dias, até a cicatrização completa. Os questionários e a manometria anorretal foram repetidos 1 mês e 3 meses após a operação. Foi avaliado o tempo para cicatrização da fissura, as alterações manométricas e as complicações decorrentes do procedimento. Resultados: Todas as pacientes apresentavam hipertonia esfincteriana interna no período pré-operatório. Após 3 meses da operação, as pressões de repouso e o comprimento do canal anal funcional diminuíram de modo estatisticamente significante. Houve redução das queixas de prurido e sangramento. A cicatrização completa da fissura ocorreu em sete pacientes. A mediana do tempo de cicatrização foi de 45 dias. Não houve complicações decorrentes do procedimento. Uma paciente apresentou incontinência transitória para flatos. Conclusões: A esfincterotomia lateral interna subcutânea proporcionou melhora clínica e diminuição das pressões de repouso dos esfíncteres anais em mulheres com fissura anal crônica.Palavras-chave: fissura anal; esfíncter anal; manometria; cicatrização.Clinical and manometric evaluation of women with chronic anal fissu...

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“…Remaining 5 patients suffered of persistent of symptoms who required repeat procedure 3 weeks later. 9 After the performance of the same procedure for the second time they were relieved of the symptoms from 2-week of the surgery. Preoperative clinical picture for most of these patients were pain on defecation few minutes to 6 hrs after defecation, bleeding on and off, sentinel skin tag.…”

Section: Discussionmentioning

confidence: 98%

Lateral partial internal sphincterotomy-a complete relief in chronic fissure in ANO

Kumar

Selvaraj

2017

Int Surg J

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INTRODUCTIONChronic fissure in ano is very common in all age group of people due to present days hi-fi method of food habits, modified life style and inborn errors of health conscience. The present generation is more moribund on the development of technology and work styles of these techis are tedious. Requirement of the remedies are long standing, permanent and symptom or complication free. Early mobilization after any procedure is the only way out for earned population. In the development of the internet medicine access leads to the attitude of clearance of the physician doubts. Based on the above wide range of criteria among these lies the choice of the treatment to be very selective and preferably high in placement of the best treatment for them.Lateral internal sphincterotomy is the only choice in the treatment of the fissure in ano. Complete Sphincterotomy and partial sphincterotomy was followed in variable individuals. 1,2 But post-operative complication like incontinence is to be made into account for the follow up ABSTRACT Background: Lateral internal sphincterotomy is the only choice in the treatment of the fissure in ano. Complete and partial sphincterotomy was followed in variable individuals. But post-operative complication like incontinence, early mobilization and early recovery is to be made into account for best results among these patients. Methods: This study is made in 2015-2016 period among 52 patients with chronic fissure in ano, partial sphincterotomy i.e., division of internal sphincter below the dentate line was performed. Post-operative follows up and symptoms were recorded, in such cases treated adequately. The period of revisit was decided according to patient compliance 1 month, 3months, 6 months. The data was collected prospectively and recorded in view of change in the treatment. Results: 47 of the patients were pain free within first 5 days of surgery. Remaining 5 patients required further division for pain relief due to persistent pain after 3 weeks. The associated post-operative complication among these patients was itching due to burning sensation in and around the anus which resolved later. None among these patients developed fecal incontinence. Conclusions: Among all age group of the patients included in this study were subjected to same type of the procedure and results were recorded to give better prognosis with lowest degree of recurrence for which repeat of the same procedure gave the complete relief. Lateral internal partial sphincterotomy is an effective technique for complete relief of pain in chronic fissure in ano.

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Long-term results of lateral internal sphincterotomy for chronic anal fissure with particular reference to incidence of fecal incontinence

Abstract: Although lateral internal sphincterotomy heals and relieves symptoms of chronic anal fissure in nearly all patients (96 percent), incontinence occurs frequently. Most episodes of incontinence are indeed minor and transient, but in a small subgroup, incontinence seems to be permanent.

Cited by 268 publications

References 19 publications

Comparative Study of Lateral Sphincterotomy versus Local 2 % Diltiazem Ointment for the Treatment of Chronic Anal Fissure

Comparative Study of Lateral Sphincterotomy versus Local 2 % Diltiazem Ointment for the Treatment of Chronic Anal Fissure

Clinical and manometric evaluation of women with chronic anal fissure before and after internal subcutaneous lateral sphincterotomy

Lateral partial internal sphincterotomy-a complete relief in chronic fissure in ANO

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