Volume : 5, Issue : 7, July - 2016

COMPARITIVE STUDY OF LATERAL INTERNAL SPHINCTEROTOMY (OPEN TECHNIQUE), LATERAL INTERNAL SPHINCTEROTOMY (CLOSED TECHNIQUE), AND ANAL DILATATION FOR FISSURE IN ANO

Dr Prashant Pandurang Jadhav, Dr Ranjeet Kamble, Dr. Nilesh Bhaskar More, Dr Satish Dharap

Abstract :

<p>&nbsp;Objectives : To compare the different surgical techniques used for surgical treatment of fissure in ano, with respect to feasibility of the procedure under local anesthesia, severity of pain during procedure , post operative symptom relief ,recurrence rates and return to normal activity. Methodology: This study was planned as a prospective randomized controlled study comparing lateral sphincterotomy by closed and open technique performed under local anesthesia with the &ldquo; standard technique&rdquo; of anal dilatation done under general anesthesia. Results :Post operatively 21 patients (70%) of the open internal sphincterotomy had moderate pain as compared to 18 patients (60%) of closed sphincterotomy after 4 hours. At day 3 the incidence of moderate pain was decreased to 20 patients (66.7%) among anal dilatation, 12 patients (40%), and 13 patients (43.33%) each in open and closed internal sphincterotomy group respectively and pain was almost subsided by the end of day 7 .Post operative symptom relief of painful defecation was seen in almost all the patients in each group The mean time period for return to normal activity was 2.8 days in anal dilatation group, 2.1 days in open sphincterotomy and 2.26 days in closed sphnicterotomy .Five patients (16.66%) in anal dilatation had recurrence at the end of 6 months, while open sphincterotomy group had 2 patients (6.66%) and closed sphincterotomy group had 4 patients (13.33%) . Conclusion: Anal sphincterotomy (both open and closed technique) are safe and effective techniques for surgical treatment of anal fissure. It is feasible to perform the procedure under local anesthesia with supplemental intravenous analgesia and sedation.</p>