Abstract
Introduction
Anal fissure is described as a linear defect, or laceration, in the anoderm, located between the dentate line and the anal verge. An acute fissure is a simple laceration, whereas a chronic anal fissure is an ulceration with built-up scarred edges and exposed internal anal sphincter muscle fibers at its base. Additional findings may include a perianal skin tag at the external margin of the fissure and a hypertrophied papilla at the dentate.
Methods
This is a randomised control study that included 50 patients, divided in two groups, who were treated with lateral internal sphincterotomyunder local anaesthesia (group A) and spinal anaesthesia (group B) in Dr. Ram Manohar Lohia Hospital, New Delhi, India, from May 2014 to November 2015. The follow-up period ranged from 2- 6 months.
Results
Fissure persistence or recurrence was found in 1 patient (4.16%) after 2 months in group B, and none in patients of group A. Wound healed by epithelization with mean of 1 week in group A, while it required 2 to 3 weeks for group B wounds to heal. There was wound infection in 5 out of 24 patients in group B (20.8%). There was no incontinence of flatus or stool in any of the patients in both groups.
Conclusions
Lateral internal sphincterotomy is now considered the treatment of choice for anal fissure, because it is a day care surgery, it causes less pain, it has negligible chances of recurrence and wound infection and is more effective in management of chronic anal fissure.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Jensen SL. Diet and other risk factors for fissure in ano. Prospective case–control study. Dis Colon Rectum 1988;31:770–3.
Bove A, Balzano A, Parotti P, et al. Different anal pressure profiles in patients with anal fissure. Tech Coloproctol 2004;8:151–6.
Ammari FF, Bani-Hani KE. Fecal incontinence in patients with anal fissure: a consequence of internal sphincterotomy or a feature of the condition? Surgeon 2004;2:225–9.
Jonas M, Scholefield JH. Anal fissure. Clin Evid 2004;11:533–43.
Ram E, Alper DY, Stein G, et al. Internal anal sphincter function following lateral internal sphincterotomy for anal fissure: a long term manometric study. Ann Surg 2005;242:208–11.
McCallion K, Gardiner KR. Progress in the understanding and treatment of chronic anal fissure. Postgrad Med J 2001;77:753–8.
Hyman N. Incontinence after lateral internal sphincterotomy: a prospective study and quality of life assessment. Dis Colon Rectum 2004;47:35–8.
Sandelwski A, Koreza J, Dyaczynski M, et al. Chronic anal fissure–conservative or surgical treatment? Waid Lek 2004;57:80–4.
Oh C, Divino CM, Steinhagen RM. Anal fissure: 20-year experience. Dis Colon Rectum 1995;38:378–82.
Mc Namara MJ, Percy JP, Fielding IR. A manometric study of anal fissure treated by subcutaneous lateral internal sphincterotomy. Ann Surg 1990;211:235–8.
Maria G, Brisinda G, Bentivoglio AR, et al. Botulinum toxin injections in the internal anal sphincter for the treatment of chronic anal fissure. Long-term results aftre two different dosage regimens. Ann Surg 1998;228:664–9.
Evans JE, Luck A, Hewett P. Glyceryl trinitate vs lateral sphincterotomy for chronic anal fissure. Prospective, randomized trial. Dis Colon Rectum 2001;44:93–7.
Brisinda G, Maria G. Oral nifedipine reduces resting anal pressures and heals chronic anal fissure. Br J Surg 2000;87:251.
Olsen J, Mortensen PE, Krogh I, et al. Anal sphincter function after treatment of fissure-in-ano by lateral subcutaneous sphincterotomy versus anal dilatation. A randomized study. Int J Colorectal Dis 1987;2:155–7.
Weaver RM, Ambrose NS, Alexander-Williams J, et al. Manual dilatation of the anus vs. lateral subcutaneous sphincterotomy in the treatment of chronic fissure-in-ano. Results of a prospective, randomized, clinical trial. Dis Colon Rectum 1987;30:420–3.
Abcarian H. Surgical correction of chronic anal fissure: results of lateral internal sphincterotomy vs fissurectomymidlinesphincterotomy. Dis Colon Rectum 1980;23:31–6.
Leong AF, Seow-Choen F. Lateral sphincterotomy compared with anal advancement flap for chronic anal fissure. Dis Colon Rectum 1995;38:69–71.
Eisenhamner S. The surgical correction of chronic anal (sphinteric) contracture. S Afr Med J 1951;25:486–9.
Notaras MJ. Lateral subcutaneous sphincterotomy for anal fissure-a new technique. Proc R Soc Med 1969;62:713.
Mohsen Towliat Kashani S, Lak M, Ali Mohebi H et al. Lateral internal sphincterotomy under local anesthesia: a randomized clinical trial. MJIRI 2006;20:37–40.
Kortbeek JB, Langevin JM, Khoo RE, et al. Chronic fissurein-ano: a randomized study comparing open and subcutaneous lateral internal sphincterotomy. Dis Colon Rectum 1992;35:835–7.
Boulos PB, Araujo JG. Adequate internal sphincterotomy for chronic anal fissure: subcutaneous or open technique? Br J Surg 1984;71:360–2.
Simkovic D, Smejkal K, Hladí K P. Evaluació n de losefectos de la esfinterotomí a en losenfermostratadosporfisura anal crónica. Rev Esp Enferm Dig 2000;92:399–401.
Author information
Authors and Affiliations
Corresponding authors
Rights and permissions
About this article
Cite this article
Sarkar, S., Kapur, N. Lateral internal sphincterotomy under local and spinal anaesthesia for chronic anal fissure: A randomised control trial. Hellenic J Surg 88, 398–401 (2016). https://doi.org/10.1007/s13126-016-0358-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13126-016-0358-y