DOI: http://dx.doi.org/10.18203/2349-2902.isj20195101

Results of tailored lateral sphincterotomy for chronic fissure in-ano

Ahemadi Firdous Nikhat, Mohd Zaheeruddin Ather

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 sphincterotomy remains the gold standard of treatment for chronic anal fissure, however it is associated with the significant rate of incontinence. This study reviews using a tailored lateral sphincterotomy by selecting the height of internal sphincter to be divided with aim of preserving more sphincter and hence reducing the incontinence rates.

Methods: The study was carried out in 50 patients who were diagnosed clinically as chronic anal fissure attending Surgery department of ESIC medical college and hospital, Kalburagi over a period of 6 months from January 2019 to August 2019. Tailored left lateral internal sphincterotomy was performed in all patients. The date was recorded and analysed. Early post-operative follow-up was maintained every week for four weeks or till the fissure healed. Complications mainly incontinence rate was assessed.

Results: Common age group was third and fourth decade of life. Pain (100%) was the commonest symptom. Majority of the patients (96%) had posterior fissure. Postoperatively about 97% patients had complete pain relief. Only one patient (2%) in the study reported incontinence to flatus during the first follow-up visit and had minor incontinence and other minimal complications were found.

Conclusions: Tailored lateral anal internal sphincterotomy is safe and effective surgical procedure for the management for chronic anal fissure with lower rate of incontinence rate compared to gold standard lateral internal sphincterotomy.


Keywords


Fissure-in-ano, Lateral sphincterotomy, Incontinence rate, Tailored left lateral internal sphincterotomy

Full Text:

PDF

References


Mapel DW, Schum M, Von Worely A. The epidemiology and treatment of anal fissures in a population- based cohort. BMC Gastroenterol. 2014;14(1):129.

Lunniss PJ. The anus and anal canal. In: Williams NS, Bulstrode CJK, O’ Connel PR, eds. Bailey & love’s short practice of surgery. 25th Ed. London Arnold; 2008:1251-1253.

Singh S, Tayal A, Singh S, Kaur V. Surgical management of chronic anal fissure: Evaluation of left lateral internal sphincterotomy (LLIS). JIMSA 2011;24(2):95-6.

Perry WB, Dykes SL, Buie WD, Rafferty JF. Standards practice task force of the American Society of Colon and Rectal Surgeons Practice parameters for the management of anal fissures (3rd revision). Dis Colon Rectum. 2010;53:1110e1115.

Nelson RL, Chattopadhyay A, Brooks W, Platt I, PaavanaT, Earl S. Operative procedures for fissure in ano. Cochrane Database Syst Rev. 2011;9:CD002199.

Hsu TC, MacKeigan JM. Surgical treatment of chronic anal fissure. A retrospective study of 1753 cases. Dis Colon Rectum. 1984;27:475e478.

Ramakant M and Mahajan M M. chronic Anal Fissure- A prospective study. IJBR. 2016;7(11):803-6.

Notaras MJ. The treatment of anal fissure by lateral subcutaneous internal sphincterotomy a technique and results. Br J Surg. 1971;58(2):96-100.

Cohen A, Dehn TC. Lateral subcutaneous sphincterotomy for the treatment of anal fissure in children. Br J Surg. 1995; 82:1341-2.

Fiducia G, Bose V. Partial left lateral subcutaneous sphincterotomy for anal fissure: role and results. Chir Ital. 2006;58:510-4.

James GP, Rimm EB, Renne JR. Clinical presentation of chronic anal fissure. Dept of surgery, Harward school of public health, Boston. American Surgeon. 1993;59:666-7.

Hsu TC, Mac keigan JM. Surgical treatment of chronic and fissure: A retrospective study of 1753 cases. Dis colon Rectum. 1884;27:475-8.

Pernikoff BJ, Eisenstat TE, Rubin RJ, Oliver CG, Salvati EP. Reappraisal of partial lateral sphincterotomy. Dis Colon Rectum. 1994;37:1291- 5.

Rosa G, Lolli P, Piccinelli D, Mazzola F, Zugni C, Ballarin A, et al. Calibrated lateral internal sphincterotomy for chronic anal fissure. Tech Coloproctol. 2005;9:127-31.

Lattoo M, Mir S, Kumar I, Rashid N. Evaluation of Tailored Lateral anal Sphincterotomy For Chronic Anal Fissure- A Prospective Study. International Journal of Medical and Biomedical Studies. 2019;3(4).

Hawley PR. Treatment of chronic anal fissure-in-ano. A trial of methods. Br J Surg. 1969;56(12):915-8.