Outcomes of lateral internal sphincterotomy for management of chronic anal fissures in a tertiary care hospital of Peshawar

Abstract

Introduction: Anal Fissure, a painful longitudinal mucosal ulcer of the anal canal is a common problem seen particularly in young and otherwise healthy adults. Lateral internal sphincterotomy remains the first line of treatment usually performed under general anaesthesia.

Objectives: To evaluate the outcomes and complications of lateral internal sphincterotomy for treatment of chronic anal fissure in Rehman Medical Institute (RMI), Peshawar.

Materials & Methods: A retrospective study was conducted at general surgery unit, RMI, Peshawar upon approval from the department of Medical Research; Data was retrieved from the RMI Data base. All patients were selected form with Chronic anal fissures who underwent lateral internal sphicterotomy from January 2016 till December 2018. The data was entered into SPSS version 22.0 for descriptive analysis. The data of these patients was evaluated for outcomes in terms of healing, recovery of pain, complications and recurrence, data was analysed for descriptive statistics in terms of frequencies using SPSS version 22.0

Results:  Out of 142 patients, 106(74.6%) were males and 36(25.4%) were females, with mean age of 42.5 ± 14.06 years, 127(89.4%) presented with pain, 64(45.1%) presented with bleeding per rectum, 53(37.3%) presented with constipation, 45(31.7%) presented with a complaint of hard stools, 36(25.4%) had sentinel pile, however, 76(53.5%) were having an increased anal tone. After longer term follow up 116(81.7%) patients had no complaints regarding pain, Bleeding per rectum 61(43 %), Constipation 53(37.3%) hard stools 43(30.28%), Increased anal tone 73(51.4%), and 29(20.4%) had no sentinel pile postoperatively. Excluding 21(14.78%) who had fecal incontinence none of the patient reported other complications like Recurrence, Sepsis or Re-bleed.

Conclusion:  Lateral internal sphincterotomy is a safe, effective, and inexpensive procedure that leads to quick symptomatic improvement and healing in chronic anal fissure with minimal complications.