A prospective, randomize study of comparison of lateral internal sphincterotomy versus Lord’s anal dilatation in chronic anal fissure
DOI:
https://doi.org/10.18203/2349-2902.isj20180824Keywords:
Chronic anal fissure, Lords anal dilatation, Lateral internal sphincterotomy, Postoperative complicationsAbstract
Background: Surgical techniques for management of chronic anal fissure are Lords anal dilatation (LAD) and Lateral internal sphincterotomy (LIS). The aim of this study is to compare the symptoms, post-operative complications and recurrence risk of the above two techniques.
Methods: It was a prospective, randomized controlled trial done in department of General Surgery of a tertiary care hospital from June 2016-May 2017. A total of 100 patients lined up for surgical management of CAF were divided into two groups (50 each). In group A, 50 patients underwent LAD and in group B, 50 underwent LIS. Patients were followed up for 6 months following surgery for pain, bleeding, incontinence, post-operative hospital stay and recurrence. Wong Baker scale, Modified Longo score and Wexner scales were used for assessment of pain, constipation and incontinence respectively. Various post-operative symptoms, complications and recurrence risk were evaluated post operatively at 24 hours, before discharge from the hospital, 1st, 3rd and 6th months of operation respectively.
Results: Male female ratio was 1.7:1. Most common presenting complaint was pain seen in 96% patients. Sentinel tag at 6 o’clock position was seen in the majority (93%) patients on presentation. Except for pain score, which was statistically more significant at 24 hours postoperatively in the LAD group (p=0.012), there was no statistical difference between the two groups when compared at different points of evaluation for symptoms, complications and recurrence (p=0.565).
Conclusions: With minor difference in pain, Lord’s dilatation has similar post-operative symptoms; complications and recurrence risk when compared with lateral internal sphincterotomy procedure, for management of CAF and can be safely performed.
References
Jensen SL. Diet and other risk factors for fissure in ano. Prospective case control study. Dis Colon Rectum. 1988;31(10):770-3.
Arroyo A, Perez F, Serrano P, Candela F, Lacueva J, Calpena R. Surgical versus chemical (botulinum toxin) sphincterotomy for chronic anal fissure: Long-term results of a prospective randomized clinical and manometric study. Am J Surg. 2005;189(4):429-34.
Lund JN, Scholefield JH. Aetiology and treatment of anal fissure. Br J Surg. 1996;83:1335-44.
Nelson R. Operative procedures for fissure in ano. Cochrane Database Syst Rev. 2005;2:2199.
Sanabani JA, Salami SA. Closed versus open lateral internal anal sphincterotomy for chronic anal fissure in female patients. Egyptian J Surg. 2014;33:178-81.
Gupta V, Rodrigues G, Prabhu R, Ravi C. Open versus closed lateral internal anal sphincterotomy in the management of chronic anal fissures: a prospective randomized study. Asian J Surg. 2014 Oct 1;37(4):178-83.
Wong DL, Hockenberry-Eaton M, Wilson D, Winkelstein ML, Schwartz P. Wong’s Essential of Pediatric Nursing, 6th Ed. St. Louis, Mosby; 2001.
Longo A. Obstructed defecation because of rectal pathologies. Novel surgical treatment: stapled transanal rectal resection (STARR). Annual Cleveland Clinic Florida Colorectal Disease Symposium, 2004.
Jorge JMN, Wexner SD. Etiology and management of fecal incontinence. Dis Colon Rectum. 1993;36:77-97.
Watts JM, Bennett RC, Goligher JC. Stretching of the anal sphincters in the treatment of fissure-in-ano. Br Med. 1965:342-4.
Nahas SC, Sobrado Jr CW, Araujo SE, Aisaaka AA, Habar GA, Pinotti HW. Chronic anal fissure: results of the treatment of 220 patients. Rev Hosp Clin Fac Med. 1997;52:246-9.
Mapel DW, Schum M, Worley AV. The epidemiology and treatment of anal fissures in a population-based cohort. Bio Med Central Gastroenterol. 2014;14:129.
Giordano P, Gravante G, Grondona P, Ruggiero B, Porrett T, Lunniss PJ. Simple cutaneous advancement flap anoplasty for resistant chronic anal fissure: a prospective study. World J Surg. 2009;33:1058-63.
Shafiq U, Nadeem M. Closed versus open lateral internal sphincterotomy in chronic anal fissure: a comparative study of postoperative complications and results. Pakistan J Med Res. 2004;43:1-4.
Mousavi SR, Sharifi M, Mehdikhah Z. A comparison between the results of fissurectomy and lateral internal sphincterotomy in the surgical management of chronic anal fissure. J Gastrointest Surg. 2009;13:1279-82.
Samual S. Anal fissure. In: Mazier WP, Leien DH, Luchfeld MA, Senagore AG, eds. Surgery of Colon, Rectum and Anus. Philadelphia, WB Saunders; 1995:255-68.
Giles GR. The colon, rectum and canal. In: Cuschieri A, Giles GR, Moosa AR, eds. Essential Surgical Practice. 3rd Ed. London, Butterworth Heinemann; 1995:1362-407.
Arroyo A, Pe´rez F, Serrano P, Candela F, Calpena R. Open versus closed lateral sphincterotomy performed as an outpatient procedure under local anesthesia for chronic anal fissure: prospective randomized study of clinical and manometric longterm results. J Am Coll Surg. 2004;199:361-7.
