DOI: http://dx.doi.org/10.18203/2349-2902.isj20182777

Feasibility of local anaesthesia in lateral internal anal sphincterotomy for chronic anal fissure

Bhimanagouda Venkanagouda Goudar, Eshwar B. Kalburgi, Yamanur P. Lamani, Veerabhadra Gowd Y. C.

Abstract


Background: Fissure in Ano is one of the common and most painful anorectal conditions encountered in surgical practice. Inspite of several conservative treatment options, surgical treatment in the form of Lateral Anal Spincterotomy (LAS) remains the gold standard of treatment for Chronic Anal Fissures (CAF).

Methods: Prospective comparative study conducted on 90 patients randomly divided into two groups Group A under Local anaesthesia (LA) and Group B under Spinal anaesthesia (SA) respectively. The primary outcome variables studied were postoperative pain, hospital stay, and cost effectiveness.

Results: A total of 90 patients randomly divided into 45 patients in each group. There was no statistically difference in the pain at surgery, but post-operative pain was significantly less in LA group at 5th hour, 24 hours after surgery. Hospital stay in LA group is significantly less when compared to SA group (1.92, 3.75 respectively).

Conclusions: LAS can be comfortably performed under LA with added advantages.


Keywords


Anal sphinteretomy, Chronic anal fissure, Local anaesthesia

Full Text:

PDF

References


Sarkar S, Kapur N. Lateral internal sphincterotomy under local and spinal anaesthesia for chronic anal fissure: A randomised control trial. Hellenic J Surg. 2016 Nov 1;88(6):398-401.

Jonas M, Scholefield JH. Anal fissure. Clin Evid. 2004;11:533-43.

Gordon PH, Vasilevsky CA. Symposium on outpatient anorrectal procedures. Lateral internal sphincterotomy: rationale, technique and anesthesia. Can Surg. 1985;28:228-30.

Hiltunen KM, Matikainen M. Closed lateral subcutaneous sphincterotomy under local anaesthesia in the treatment of chronic anal fissure. Ann Chir Gynaecol. 1991;80:353-6.

Sanchez Romero A, Arroyo Sebastian A, Perez Vicente F, Serrano Paz P, Candela Polo F, Tomas Gomez A, et al. Open lateral internal anal sphincterotomy under local anaesthesia as the gold standard in the treatment of chronic anal fissures. A prospective clinical and manometric study. Rev Esp Enferm Dig. 2004;96(12):856-63.

Arroyo A, Perez F, Serrano P, Candela F, Calpena R. Open versus closed lateral sphincterotomy performed as an outpatient procedure under local anaesthesia for chronic anal fissure: prospective randomized study of clinical and manometric longterm results. J Am Coll Surg. 2004;199(3):361-7.

Liratzopoulos N, Efremidou EI, Papageorgiou MS, Kouklakis G, Moschos J, Manolas KJ, et al. Lateral subcutaneous internal sphincterotomy in the treatment of chronic anal fissure: our experience. J Gastrointestin Liver Dis. 2006;15(2):143-7.

Gudityte J, Marchertiene I, Pavalkis D. Anesthesia for ambulatory for anorectal surgery. Medicina (Kaunas). 2004;409:101-11.

Bell GA. Lateral internal sphincterotomy in chronic anal fissure--a surgical technique. The American Surgeon. 1980.46:572-75.

Briggs M, Closs JS. A descriptive study of the use of visual analogue scales and verbal rating scales for the assessment of postoperative pain in orthopedic patients. J Pain Symptom Manage. 1999;18(6):438-46.

Murad-Regadas SM, Fernandes GO da S, Regadas FSP, Rodrigues LV, Pereira J de JR, Regadas Filho FSP, et al. How much of the internal sphincter may be divided during lateral sphincterotomy for chronic anal fissure in women? Morphologic and functional evaluation after sphincterotomy. Dis Colon Rectum. 2013;56(5):645-51.

Hiltunen KM, Matikainen M. Closed lateral subcutaneous sphincterotomy under local anaesthesia in the treatment of chronic anal fissure. Ann Chir Gynaecol. 1991;80(4):353-6.