Home Safety and Efficacy of Lateral Internal Sphincterotomy in the Management of Chronic Anal Fissure

Safety and Efficacy of Lateral Internal Sphincterotomy in the Management of Chronic Anal Fissure

*Dr. M. H. Mahmud

Assistant Professor Department of Surgery Prime Medical College, Rangpur.

Dr. Md. Mushfiqur Rahman

Associate Professor Department of Surgery, Prime Medical College, Rangpur.

Dr. Ahmed Al Amin

Assistant Professor Department of Surgery Jalalabad Ragib Rabeya Medical College, Sylhet

Dr. Md. Amzad Hossain

Junior Consultant (C.C) Department of Surgery Aditmari Upazila Health Complex, Lalmonirhat.

Dr. Moriam Pervin

Assistant Professor Department of Anesthesiology Prime Medical College, Rangpur.

Dr. Md. Mehedi Hasan

Registrar Department of Surgery Prime Medical College, Rangpur.

Keywords: LIS, Chronic anal fissure

Abstract

BACKGROUND: An Anal Fissure is a painful longitudinal mucosal ulcer of the anal canal which may extend from the anal verge to the dentate line. It can significantly influence the quality of life of the affected person due to its troubling symptoms and signs such as severe pain, bleeding per rectum, spasm of the internal sphincter. Lateral internal sphincterotomy (LIS) is one of the most common procedure perfomed when conservative management fails in chronic anal fissure.

OBJECTIVES: The aim of the study is to assess the safety and efficacy of lateral internal sphincterotomy for the management of chronic anal fissure.

MATERIALS AND METHODS: This descriptive type of observational study was carried out at department of surgery of Prime Medical Hospital, Rangpur from July, 2020 to June, 2022 in 105 patients suffering from chronic anal fissure and underwent LIS after medical management failed. Age, sex, clinical presentation, symptomatic relief of defecatory pain following LIS, post-operative complications were assessed in all patients.

RESULTS: All 105 patients were between the 18 to 68 years of age. The mean age of the respondents was 37.32 ± 9.92 years and male to female ratio was 1: 2.28 with a slight predominance of female. Painful defecation (98%), Constipation (98%) and bleeding per anul (82%) were the most common complaints. Symptomatic relief of pain following operation was observed among all the patients at 6^th week . The early complications in the present study were bleeding (0.7%), perianal infection (0.3%). In our study only 0.4%, patients showed gas incontinence, which itself got improved after some time. In our study no patient suffered from recurrence in 3 months period.

CONCLUSION: Our study shows that lateral internal sphincterotomy is a safe surgical option for treatment of chronic anal fissure. It improves the existing symptoms rapidly and there are few post-operative complications which can be managed. Flatus incontinence may occur but it resolves with time and there is reduced chance of recurrence.