LATERAL INTERNAL SPHINCTEROTOMY

AN EFFECTIVE OPTION IN THE TREATMENT OF CHRONIC ANAL FISSURE

Abstract

Objective: To observe the prevalence of anal fissure, and outcome of open lateral internal sphincterotomy in terms of symptomatic relief, fissure healing and complications of procedure in female population. Study Design: Cross sectional, Prospective interventional. Setting & Duration: Surgical Unit DHQ (Teaching) Hospital Rawalpindi, Women Medical Complex Sialkot over a period of seven years from 2003 to 2010. Methodology: Female Patients with chronic anal fissure with history of failed conservative treatment were included in the study after taking informed consent. All patients were evaluated and managed by consultant General Surgeon and were subjected to open lateral internal sphincterotomy (LIS). Results: Two hundred and seventy three female patients of mean age of 39.5 years with chronic anal fissure and history of failed / noncompliance to conservative treatment were enrolled in this study. All patients underwent open lateral internal anal sphincterotomy. Post operatively had excellent recovery, were ambulant on same day. Minor complications were noted in 44 patients (0.16%). Moderate pain at operation site was the commonest complication seen in 32 patients (0.11%). No major complication like permanent incontinence of flatus and feces or recurrence was reported in any of the patients. Conclusions: Lateral internal sphincterotomy remains an effective treatment for chronic anal fissure in the hands of experienced surgeon with highest patient satisfaction, and should be considered as the first line therapy in chronic and resistant / recurrent acute anal fissures.