Comparative study of manual anal dilatation and lateral internal anal sphincterotomy in the treatment of acute anal fissure
Keywords:Manual anal dilatation, Lateral internal anal sphincterotomy, Acute anal fissure
Background: An anal fissure is an extremely common condition which is also one of the most painful condition. It can be very troubling because, if acute, the severity of patient discomfort and extent of disability far exceed that which would be expected from a seemingly trivial lesion. This study compares two most commonly done procedures for anal fissure, manual anal dilatation (MAD) and lateral internal anal sphincterotomy (LAS).
Methods: This is a prospective cohort study comparing MAD and LAS in the treatment of chronic anal fissure at Sri Venkateswara Medical College, Tirupati, from December 2017 to December 2018. A total of 60 patients who met inclusion criteria were randomized to undergo either MAD or LAS and analyzed for post-operative pain, post-operative complications, hospital stay, recurrence rates and compliance.
Results: Total 60 patients were randomized to MAD and LAS. The patients who have undergone LAS have better pain relief and slightly increased risk of infection. Those who have undergone MAD have less risk of infection and recurrence rates and complications are not significantly less than LAS.Conclusions:MAD and LAS are both equally effective and safe for treatment of acute anal fissure with less chances of recurrence. However postoperative pain was slightly more in MAD group.
Essani R, Harry T. Papaconstantinou Shackelford's Surgery of the Alimentary Tract. 8th ed. page 1864-1870.
Schouten WR, Brie JW. Relationship between anal pressure and anodermal blood flow. The vascular pathogenesis of anal fissure. Dis Colon Rectum. 1994;37(7):664-9.
Steele SR, Hull TL. The ASCRS Manual of Colon and Rectal Surgery; 2019:171-9.
Petros JG, Rimm EB. Clinical presentation of chronic anal fissures. Am Surg. 1993;19(10): 666-8.
Weaver PA, Ambrose NS. Fissure in ano, risk factors (Comment). Dis Colon Rectum. 1999;32(6):545.
Russel RCG, Williams NS. Anal fissure. Bailey and Love. Text by Norman Williams: In a Short Text Book of Surgery. Arnold Publishers, London; 2000: 1125-7.
Gibbons CP, Reed NW. Anal Hypertonia in fissures: causes or effect. Br J Surg. 1988;73(6):443-5.
Hardy JD, Kukora JS. Anal fissure. In Hardy’s Textbook of surgery, 2nd Edition, Philadelphia; 1998, 626-8.
Morris PJ, Malt RA. Fissure in Ano. Oxford textbook of surgery, New York; 1994;1139-40.
Goldstein SD. Anal fissures and fistulas. Postgrad Med. 1987;82(7):186-92.
Lindsey I, Jones OM, Cunningham C, Mortensen NJ. Chronic anal fissure. Br J Surg. 2004;91:270-9.
Conze J, Kingsnorth AN, Flament JB, Simmermacher R, Arlt G, Langer C, et al. Randomized clinical trial comparing lightweight composite mesh with polyester or polypropylene mesh for incisional hernia repair. Br J Surg. 2005;92(12):403-4.
Lambe GF, Driver CP, Fissurectory as treatment for anal fissure in children. Ann Royal Coll Surg England. 2000;82:254-25.
Sultan A II. Prospective study of the extent of internal anal sphincter division during lateral sphincterotomy. Diseases Colon Rectum. 1994;37(10):1031-3.
Kortbeak JB, Langerine JM. Chronic fissure in ano: a randomised study comparing open and subcutaneous lateral internal sphincterotomy. Dis Colon Rectum. 1992;35(9);835-7.
Saad AM, Omer A. Surgical treatment of chronic fissure in Ano. East African Med J. 1992;69(11):613-5.
Nelson RL. Meta-analysis of operative techniques for fissure in ano. Dis Colon Rectum. 1999;42(11):1428-38.
Sánchez Romero A, Arroyo Sebastián A, Pérez Vicente F, Serrano Paz P, Candela Polo F, Tomás Gómez A, et al. Open lateral internal anal sphincterotomy under local anesthesia 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.
Garner MJP, Mcfall M, Edwards MDP. The Medical And Surgical Management Of Chronic Anal Fissure. J Royal Army Med Corps. 2002;148(3):230 -5.
Giusepe Brisinds MI, Giorgio M. Injection of Botulinum toxin in treatment of chronic anal fissure. New Eng J Med. 1999;341(2):65-8.
Knight GS, Birks M, Farouk R. Topical diltiazem ointment in the treatment of chronic anal fissure. Br J Surg. 2002;88:553-6.
Metcalf AM. Anal fissure. Surg Clin North Am. 2002;82(6):1291-7.
Nyam DC, Wilson RG. Island advancement flaps in management of anal fissures. Br J Surg. 1995;82(3):326-8.
Corman ML. Anal fissure in Colon and Rectal Surgery. Philadelphia; 1999: 116 – 131.
Prohm P, Bonner C. Is Manometry essential for surgery of chronic fissure in ano. Dis Colon Rectum. 1995;38(7):35-8.
Felt Bersnia RJ. Unsuspected sphincter defects shown by anal endosonography after anorectal surgery. Dis Colon Rectum. 1995;65(2):10-8.
Khubchandani IT, Reed JF. Sequelae of international sphincterotomy for chronic fissure in ano. Br J Surg. 1989;76(5):431-4.
Neufeld DM, Paran H. Out patients surgical. European J Surg. 1995;161(6):435-8.,
Parklea PT. Fissure in ano - A ten-year retrospective study. M Med Dissertation, 1992.
Cohen A, Dehn TC. Lateral internal Sphincterotomy for treatment of anal fissures in children. Br J Surg. 1995;82(10):1341-2.
Notorras MJ. Anal fissure and stenosis. Surg Clin North Am. 1988;68(6):1427-40.