A study of outcome after lateral internal anal sphincterotomy for anal fissure

Abstract

Anal fissure is a common and painful condition which causes significant morbidity in the population. If conservative treatment fails or fissure recurs (frequently), a surgical treatment is indicated. Three surgical procedures are available. 1. Anal sphincter stretching (dilatation), 2. Lateral internal anal sphincterotomy, and 3. Anal advancement or rotation flap. Sphincter stretching has now become practically obsolete. A flap may be indicated in women who have had previous sphincter damage. Otherwise, lateral internal anal sphincterotomy is the surgical procedure of choice in most of the patients. The operative procedure may be performed by closed technique or open technique, and under local analgesia, caudal block, or general anaesthesia. We prefer open technique under general anaesthesia. A retrospective analysis of patients with anal fissure who underwent lateral internal anal sphincterotomy, was done in our hospital attached to a rural medical college. The period of study was one year. The patients were followed up for 06 months after the operation, and evaluated for relief of pain, incontinence of faeces or flatus or both, wound haematoma and wound infection. Pain was relieved, and the pain relief was maintained in majority of patients. Incontinence to flatus occurred in 30 (68.18%) patients. Incontinence to faeces, of a ‘minor degree’ though, occurred in 9 (20.45%) patients. Interestingly, none of the patients suffered from wound haematoma and infection. Also, none of the patients came back with recurrence during the study period of six months after the operation. Open lateral internal anal sphincterotomy is a safe procedure with excellent results.