Harshad Shankarlal Patel1, Jagdish Chavda1, Jayesh Parikh2, Nehal Naik3. 1. Assistant Professor, Department of Surgery, GMERS Medical College , Sola, Ahmedabad, Gujarat, India . 2. Associate Professor, Department of Surgery, B.J. Medical College , Ahmedabad, Gujarat, India . 3. Professor, Department of Surgery, GMERS Medical College , Sola, Ahmedabad, Gujarat, India .
Abstract
INTRODUCTION: Anal fissure causes significant morbidity in the population. It is proposed that elevated sphincter pressures may cause ischaemia of the anal lining and this may be responsible for the pain of anal fissures and their failure to heal. When pharmacologic therapy fails or fissures recur frequently, lateral internal sphincterotomy is the surgical treatment of choice. MATERIAL AND METHODS: Retrospective analysis was done of admitted and operated patients of anal fissure by lateral anal internal sphincterotomy either by open or closed technique between April 2010 and November 2011 in Gujarat Medical Education & Research Society Medical College, Sola, Ahmedabad, India. The follow-up data of all patients was evaluated for pain relief, recurrence, wound infection, incontinence to flatus or stool or both for a period of up to 6 months. RESULTS: Wound infection rate was 10.3% in open method and 4.2% in closed method. Incontinence to flatus was 8.3% in closed method and 3.4% in open method. This was temporary and controlled within a 1 week. Incontinence to stool was 3.4% in open method which was temporary and controlled within 2 weeks while none in closed method. None of the patients in either group had come with recurrence within 6 months follow-up. CONCLUSION: Lateral anal internal sphincterotomy is safe regarding long term incontinence and effective regarding recurrence.
INTRODUCTION: Anal fissure causes significant morbidity in the population. It is proposed that elevated sphincter pressures may cause ischaemia of the anal lining and this may be responsible for the pain of anal fissures and their failure to heal. When pharmacologic therapy fails or fissures recur frequently, lateral internal sphincterotomy is the surgical treatment of choice. MATERIAL AND METHODS: Retrospective analysis was done of admitted and operated patients of anal fissure by lateral anal internal sphincterotomy either by open or closed technique between April 2010 and November 2011 in Gujarat Medical Education & Research Society Medical College, Sola, Ahmedabad, India. The follow-up data of all patients was evaluated for pain relief, recurrence, wound infection, incontinence to flatus or stool or both for a period of up to 6 months. RESULTS: Wound infection rate was 10.3% in open method and 4.2% in closed method. Incontinence to flatus was 8.3% in closed method and 3.4% in open method. This was temporary and controlled within a 1 week. Incontinence to stool was 3.4% in open method which was temporary and controlled within 2 weeks while none in closed method. None of the patients in either group had come with recurrence within 6 months follow-up. CONCLUSION: Lateral anal internal sphincterotomy is safe regarding long term incontinence and effective regarding recurrence.
Authors: Leo Francis Tauro; Vittal V Shindhe; P Sathyamoorthy Aithala; John J S Martis; H Divakar Shenoy Journal: Indian J Surg Date: 2011-05-08 Impact factor: 0.656