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Lateral internal anal sphincterotomy for anal fissure: with or without associated anorectal procedures
Shahab Ahmed Syed1, Salman Waris, Ejaz Ahmed
1Department of General Surgery/Medicare Hospital and Fatima Medical Centre, Multan/ Nishtar Medical College and Hospital, Multan. shahabahmedsyed@hotmail.com
Objective:
To confirm or refute the validity of the fear associated with anal sphincterotomy for anal fissure, particularly when performed with other anorectal procedures.
Design:
Descriptive study.
Place And Duration Of Study:
Surgical Wings - Medicare Hospital and Fatima Medical Center, Multan, over a period of 8 years from January 1994 to December 2001.
Subjects And Methods:
Records of 112 anal fissure patients, 46 (41.0%) males and 66 (58.9%) females, ranging in age from 12-95 years (mean 39) were studied. All patients with acute or chronic anal fissures with or without other anorectal pathologies were included. Seventeen patients who had anal dilatation and 2 recurrent fissures were excluded. Open technique of anal sphincterotomy was employed in all cases. Results were recorded and analyzed.
Results:
Fissures were acute in 16 (14.2 %) and chronic in 96 (85.7 %) patients. Anterior fissure was present in 20 (17.8%), posterior in 80 (71.4%), both in 9 (8.0%) and lateral or multiple fissures in 3 (2.6%) cases. Commonest associated pathology was haemorrhoids; encountered in 64 (57.1%) patients. Minor complications, taken together, occurred in 20 (17.8%) patients. Urinary retention was seen in 3 (2.6%) with lateral internal anal sphincterotomy (LIAS), and in 6 (5.3%) where haemorrhoidectomy was added. Haemorrhage in 2 (1.7%), temporary loss of flatus control in 3(2.6%) and soiling of clothes in 2 (1.7%) patients was encountered. No permanent loss of flatus or faecal control and recurrence has been reported to-date.
Conclusion:
Anal sphincterotomy with or without other anorectal procedures can be safely practiced in properly selected patients. Postoperatively, ablution with mild antiseptic added to plain water is adequate in maintaining hygiene to promote healing.
Insights
Anal sphincterotomy for anal fissures is safe, even with other procedures. Proper hygiene post-surgery aids healing, with no permanent loss of control reported.
Area of Science:
- Colorectal Surgery
- Gastroenterology
Background:
- Anal fissures are common, often causing significant pain and fear regarding treatment.
- Anal sphincterotomy is a primary surgical intervention for anal fissures.
- Concerns exist regarding the safety of anal sphincterotomy, especially when combined with other anorectal surgeries.
Purpose of the Study:
- To evaluate the safety and efficacy of anal sphincterotomy for anal fissures.
- To determine if combining anal sphincterotomy with other anorectal procedures increases complication risks.
Main Methods:
- A descriptive study analyzing records of 112 anal fissure patients over 8 years.
- Patients underwent open technique of internal anal sphincterotomy.
- Data on fissure type, associated pathologies, and postoperative complications were recorded.
Main Results:
- Chronic fissures (85.7%) were more common than acute fissures (14.2%).
- Hemorrhoids were the most frequent associated pathology (57.1%).
- Minor complications occurred in 17.8% of patients, including temporary urinary retention and flatus control issues; no permanent loss of bowel control or recurrence was observed.
Conclusions:
- Anal sphincterotomy is a safe procedure for selected patients with anal fissures.
- Combining anal sphincterotomy with other anorectal surgeries does not appear to significantly increase risks.
- Postoperative hygiene with mild antiseptic solutions promotes healing.