A comparison between the results of fissurectomy and lateral internal sphincterotomy in the surgical management of chronic anal fissure

Abstract

Aim: To assess the result of fissurectomy and lateral internal sphincterotomy in terms of pain, bleeding, urinary retention, incontinence to flatus and faeces, perianal infection, anal stenosis and recurrence rate in chronic anal fissure. Study Design: It is a comparative study. Place and duration: Surgical unit I Amna Inayat medical college from May, 2011 to April, 2016. Methodology: A total of ninety patients were included in the study. They were randomly divided into two groups, Fissurectomy (F) group and Lateral Internal Sphincterotomy (LIS) group. Forty three patients underwent fissurectomy (F) and forty seven patients underwent open lateral internal sphincterotomy (LIS).We assessed the patients after a median follow up of 18 months for early post-operative complications, persistence of symptoms and late post postoperative complication including recurrence. Results: All patients in both groups were pain free and no bleeding in 1stpost-operative week. Urinary retention was noted in five patients, four in group (F) 4(9.30%) and one patient in group (LIS) 1(2.12%). Incontinence to flatus was noted in 3 patients 3(6.97 %) in F group and no patient in (LIS) group n= 0. Incontinence to faeces (faecal soiling) in 2 patient 2(4.65%) in group F, but no incontinence to faeces noted in LIS group n = 0. No patient in either group was afflicted with anal stenosis or perianal infections. There were 3 patients 3(6.97%) developed recurrence of fissure in F group while non in the LIS group (n=0). Almost all wounds healed within 10 weeks. 46 patient 46(97.87%) in LIS group and 40 patients in group (F) 40(93.02%) were satisfied with the treatment. Conclusion: Lateral internal sphincterotomy is the treatment of choice for the chronic anal fissure, recurrent fissure and cases which are resistant to the medical treatment.