Posterolateral Internal Sphincterotomy as a Novel Technique for Treatment of Chronic Fissure in Ano with Large Skin Tags: An Experience of 50 Cases

Abstract

Introduction: Fissure in ano is a common benign anorectal condition affecting individuals of all age groups. The gold standard treatment for fissure in ano is lateral internal sphincterotomy with excision of the skin tag if necessary. In this study, we performed a sphincterotomy at the posterolateral 5 o' clock position under vision using the same incision taken to excise the skin tag and primarily closing the wound. The patients were then evaluated based on various variables like incontinence, pain, wound healing and duration of hospital stay. Methods: 50 patients were selected as per the inclusion criteria and included in our study. Written informed consent was taken from every patient. Posterolateral internal sphincterotomy was performed for every patient with excision of skin tag through one incision. Patients were discharged from the hospital the next day and followed up at 2 weeks, 6 weeks post operatively and then for upto 6 months and the results were noted. Results: Patients had a low post operative pain score and low average duration of hospital stay. Incontinence rates were comparable to lateral internal sphincterotomy, and no patient had complete incontinence to stool. There was zero incidence of keyhole deformity and also a low incidence of wound breakdown which has been further described in the study. Conclusion -To conclude, PLIS is a safe and effective method for treatment of chronic Fissure-in-ano which is easy to perform. PLIS is, however, a new technique with less research available and it would benefit from a study with a larger sample size.