OBJECTIVES To compare open and closed techniques of lateral internal sphincterotomy
in terms of pain relief and post operative complications.
DESIGN: It was a prospective, quasi-experimental study.
PLACE AND DURATION OF THE STUDY Surgical department, Combined Military
Hospital Quetta. From May 2007 to April 2008
SUBJECTS AND METHODS: Sixty patients with chronic anal fissure were included in
the study after taking informed consent. Thirty patients were randomized into each
group (A & B). Group ‘A’ patients were treated by open while those in Group ‘B’ were
treated by the closed technique under general anesthesia (GA) or caudal anesthesia.
Patients were discharged and called/ contacted for follow up after two weeks, six weeks
and six months.
RESULTS: Sixty patients (48 males and 12 females), aged 20 to 48 years with chronic
anal fissure had lateral internal sphincterotomy. Satisfactory pain relief (more than 50%
reduction) was equivalent, 28 (93.33%) in Group A compared to 27 (90%) in Group B.
Immediate/ early complications were equivocal as only one patient with open technique
developed post operative hemorrhage and one with closed sphincterotomy had hematoma
formation. There were no cases of infection/ abscess formation. Among late complications,
recurrence was slightly more common in closed sphincterotomy (2/30 compared to 1/30),
while there was a slightly higher incidence (3/30 compared to 2/30) of incontinence in
open technique. Overall new onset incontinence was however significant (5/60 or 8.33%).
None developed postoperative fistulae.
CONCLUSION: There is no significant difference between open and closed lateral
internal sphincterotomy in terms of symptomatic relief and postoperative complications
in patients of chronic anal fissure.
KEY WORDS: 1.Chronic Anal Fissure 2.Lateral Internal Sphincterotomy 3.Anal
Anal fissure is one of the most common causes of severe anal pain. It commonly affects
young and middle-aged adults. Anal fissures occur with equal frequency i