CHRONIC FISSURE-IN-ANO

LATERAL INTERNAL SPHINCTEROTOMY VS MANUAL DILATATION OF ANUS

Abstract

Aims and Objectives: (1) To compare the effectiveness of
manual dilatation of anus and lateral internal sphincterotomy in chronic anal fissure. (2) To calculate the
complications rate i.e. incontinence, and recurrence of disease in two procedures. Setting: Allied/ DHQ
Hospitals (PMC) Faisalabad. Period: From August 1999 to September 2001. Design: A prospective
randomized study. Materials and Methods: Consecutive forty patients (Male-26, Female-14) irrespective of
age and sex were included in this trial, after taking written informed consent. The diagnosis of chronic fissure-inano
was made on the basis of typical clinical features. The diagnosis was confirmed on examination under
anaesthesia (EUA). Sigmoidoscopy was done in all cases to look for evidence of any associated disease. Biopsy
of the fissure was taken to sort out the aetiological factors like tuberculosis, Crohn’s disease and carcinoma.
Randomization: Patients having odd serial number were treated by manual dilatation of anus and patients
having even serial numbers were dealt with by lateral internal sphincterotomy either under spinal or general
anaesthesia. A follow-up was done for 3,6 and 12 weeks. Technique: Patients having chronic fissure-in-ano
were admitted in the ward from outpatient department. MDA was performed as described by Watts et al. Lateral
internal sphincterotomy was always performed on the left lateral side with the patient in the lithotomy position.
Patients were followed-up regularly at intervals of 3,6 and 12 weeks. At follow-up, symptoms were assessed on
a pre-designed questionnaire. Statistical evaluation was done by t-test. Conclusion: Lateral internal
sphincterotomy is the treatment of choice in patients with chronic fissure-in-ano resistant to conservative
measures. It has no permanent side effects and is well tolerated.