Original Research Article
Year: 2019 | Month: October | Volume: 9 | Issue: 10 | Pages: 105-110
Lateral Internal Sphincterotomy versus Anal Dilatation in Chronic Anal Fissure - An Observational Study
Rakesh Kumar Pandit1, Vinay Kumar Jha2
1Associate Professor and Head, Department of Surgery, Janaki Medical College and Teaching Hospital, Janakpur, Nepal
2Assistant Professor, Department of Surgery, Janaki Medical College and Teaching Hospital, Janakpur, Nepal
Corresponding Author: Rakesh Kumar Pandit
ABSTRACT
Background and Objectives: Both anal dilatation (AD) and lateral internal sphincterotomy (LIS) are practiced in our hospital for treatment of chronic anal fissure (CAF). The objective of the study was to compare the two procedures especially regarding pain relief, ulcer healing, incontinence and recurrence.
Material and Methods: This is an observational study and included 50 patients of AD (Group A) and 44 patients of LIS (Group B). The average follow-up was 3.5 ± 4.9 (range, 1-9) months.
Results: By the end of 1 month pain relief was observed in 45 (90%) and 42 (95.45%) patients and ulcer healing in 47 (94%) and 43 (97.7%) patients in group A and B respectively. By the end of 3 months, minor incontinence including mucous discharge was observed in 12 (24%) and 3 (6.8%) patients in group A and B respectively and the difference was significant (p=0.046). None had major incontinence. Eight (16%) and 1 (2.27%) patients in group A and group B respectively reported with recurrence (p = 0.05) during the study period and thereafter.
Conclusion: Both AD and LIS provides early pain relief and high ulcer healing rate. However, LIS appears to be safer with regard to incontinence, and the chance of recurrence is also lower compared to AD. Larger scale randomized study with longer follow up should be conducted to better define the issue of incontinence and recurrence.
Key words: anal fissure, sphincterotomy, anal pain, incontinence