Out come of closed internal sphincterotomy in chronic Anal Fissure: a prospective study at Saidu Teaching Hospital Swat.

Abstract

BACKGROUND: Anal fissure is a longitudinal tear in the lining mucosa of lower anal canal which causes painful defecation and mild streaking of blood when passing hard stool. It is associated with classical triad of anal ulcer, sentinel tag and hypertrophic papilla. This common problem had been traditionally managed by anal dilatation. In present work, we wanted to look for the safer method of sphincterotomy as a quick and effective procedure.

OBJECTIVE: To study the outcome of Closed Internal Sphincterotomy in chronic anal fissure in terms of healing , pain relief and associated complications.

MATERIAL & METHODS: This Prospective study was conducted at Surgical “B' Unit Saidu Teaching Hospital, Swat from July 2014 to June 2017. 139 patients with chronic anal fissure irrespective of age & gender were included in the study. Patients with previous Sphincterotomy, anal dilatation and suspicion of malignant fissure, atypical fissure or ulcer with associated abscess and those with un controlled diabetes or on anti coagulation therapy were excluded from the study. All patients underwent Closed Internal Sphincterotomy and were observed for 24 hour in the ward and with 2 weeks , 6 week and 6 months interval follow up. Data were recorded on predesigned proforma and analysed with SPSS version 

 RESULTS: Out of the total of 139 patients, 127 patients were followed-up at 2nd , 6th week and 6th month, while 12 patients lost to follow up. Common presenting symptoms were pain in 112 (81%) , bleeding 76(55%) and pruritis in 7(5%) patients. Pain was relieved within 24 hours in 136 (98%) while in a week time in 3(2%) patients. One patient (0.72%) had reactionary bleeding which was controlled with pressure dressing while one (0.72%) had bleeding which needed re-exploration of the wound. Transient flatus incontinence was observed in 2(1.48%) , while no patient had any faecal soiling. All of the 127 patients had complete healing of fissure by 6 weeks. 2(1.48%) patients had recurrent fissure after few months and were treated by sphincterotomy at the opposite side. 3(2.2%) developed wound infection which responded to antibiotic therapy.

CONCLUSION: Closed lateral internal sphincterotomy is a safe and effective procedure that leads to quick symptomatic improvement and healing in chronic anal fissure with minimal complication rates.