A comparative study between lateral internal sphincterotomy alone with combined lateral internal sphincterotomy, fissurectomy and primary repair of the defect in the treatment of chronic anal fissure: a randomized control study.

Abstract

Objective: The objective of this study was to compare the effectiveness of lateral internal sphincteromy alone with combined lateral internal sphincteromy, fissurectomy and primary repair of the defect in the surgical management of chronic anal fissure, in respect  of long term fissure recurrence and patient’s satisfaction. Background:  The effectiveness of lateral internal sphincterotomy alone versus combined lateral internal sphincterotomy, fissurectomy and primary repair of the defect were described and evaluated. Material and methods: This randomized control study was done on 30 patients attended the department of surgery with the history of chronic anal fissure and were aged between 18 years to 60 years. The patients were divided randomaly into two equal groups(Group I underwent lateral internal sphincterotomy alone and Group II underwent combined lateral internal sphincterotomy, fissurectomy and primary repair of the defect).Patients of both the groups were discharged from the hospital on third postoperative day. Both the groups were evaluated for postoperative pain, fissure healing, complications and postoperative reccurence of the symptoms. Result: In the present study, all patients of group I became pain-free within one week, whereas in group II the time elapsed to
became pain-free was two weeks. Three patients(20%) of group I had retention of urine, whereas in group II it was in four(26.66%).Bleeding spots were seen in two patients(13.33%) in group I, whereas in group II it was in eight(53.33%).Incontinence of flatus seen in two patients(13.33%) in group I, whereas one patient(6.66%) in group II. There were equal number of patients having incontinence of liquid and solids in both the groups(6.66%). There were two patients (13.33%) having recuurence of symptoms within six months of follow up in group I whereas nil in group II for the same period. At one year of follow up five patients(33.33%) in group I and nil in group II patients having reccurence of symptoms. After one year of follow up eight patients(53.33%) in group I and one patient (6.66%) in group II having reccurence of symptoms. Conclusion: In the present study, it has been found that the combined lateral internal sphincterotomy, fissurectomy and primary repair of the defect was the better treatment option for chronic anal fissure than lateral internal sphincterotomy alone in respect of the reccurence of symptoms on long term basis.