LATERAL INTERNAL SPHINCTEROTOMY

OUTCOME AND COMPLICATIONS

Abstract

Anal fissure is a common anorectal problem, presenting with pain during and after defecation. It is associated with
increased tone of the internal anal sphincter muscle. The relief of this hypertonia is the cornerstone of the treatment of the anal fissure. The
surgical relief of this hypertonia is very successful in treating the fissure with minor morbidity of the procedure. Patients & M e t h o d s : A study
was conducted in 486 patients,(344-males and 142 females,25-40 range). Setting: Saad Surgi-med hospital Faisalabad. Period: 1999
to 2007. Lateral internal anal Sphincterotomy for chronic anal fissure. The therapeutic outcome and complications of the procedure were
recorded. Results: Out of 486 patients, 344 were males and 142 females.frange 25-40) The site of fissure was in posterior midline 6 O' clock
in 350 patients.(m=257,f=93);Anterior midline. 12 O'clock in 99 patients.(m=76,f=23);both anterior and posterior in 41 patients.(m=l 5,f=26)
Eleven patients had associated peri-anal abscess and 19 patients had associated Fistula in ano. All the patients were discharged after 24
hrs with regular follow up at 1,2,6,24 wks. 275 patients had significant relief of pain in 48 hrs, 107 became pain free in 1 wk.37 has had some
pain for 2 wks. In 479 patients fissure healed in 3 months, 7 patients has had delayed healing out of which five patients required curettage
of the wound under local anaesthesia which healed subsequently in next six wks. 12 patients had minor incontinence which
disappeared in 4 wks. In one patient the incontinence persisted for six months then it got settled. Conclusion: Lateral subcutaneous internal
Sphincterotomy is a safe and effective treatment of chronic anal fissure.