Lateral internal sphincterotomy for surgically recurrent chronic anal fissure

Liang, Jennifer; Church, James M.

doi:10.1016/j.amjsurg.2015.05.005

Cited by 29 publications

(32 citation statements)

References 37 publications

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“…All these results are also consistent with statistics given in the literature. [11][12][13]15 Sentinel skin tag, a feature of chronicity of fissure in ano was observed in 94.4% patients in the present study which is quite consistent with available Indian studies. 12,14 The only issue in Indian scenario is to clip off the skin tag as patient after surgery becomes totally asymptomatic except the complaint of the persistent anal skin tag.…”

Section: Discussionsupporting

confidence: 81%

“…11 Pain on defecation was the chief presenting complaint in all patients of the present study, which is quite consistent with the reported studies from Egypt, United Kingdom, Canada and India. 9,11,13,14 However except one study from India, only half of the patients had a pain on defecation and a quarter of patients with bleeding per rectum, the reason could be the selection of cases of chronic fissure in ano in remission phase. 12 In the present study, the majority of patients presented with the phase of exacerbation.…”

Section: Discussionmentioning

confidence: 99%

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A comparison of segmental internal sphincterotomy versus lateral internal sphincterotomy in management of chronic fissure in ano

et al. 2017

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INTRODUCTIONFissure in ano is a common benign and painful proctologic disease causing considerable morbidity and affecting the quality of life. 1 The cause of fissure in ano remain to be defined but expected view is a combined effect of constipation (hard stools), internal anal sphincter hypertonia and certain predisposing factors like smoking, alcohol consumption of high fat diet, non-vegetarian diet etc.2-4 Medical management is the first line of treatment in all fissure in ano which aims to regulate the bowel movements by high fiber diet, stool softener, osmotic laxatives and topical medications which consist of local anaesthetic and anti-inflammatory agent which reduces the local pain and irritation. The ideal treatment for reducing the hypertonicity of anal sphincter is debatable and it could be medical or surgical manipulation which remains the cornerstone of the treatment. 2 Lateral internal sphincterotomy, remains the most effective and timetested surgical procedure for treatment of chronic fissure ABSTRACT Background: Fissure in ano is one of the commonest benign and painful proctologic condition encountered in surgical practice treated by conservative line of management. Lateral sphincterotomy is the ideal treatment option for chronic refractory fissure in ano. A newer modality segmental internal sphincterotomy shows good promise in terms of early resolution of symptoms, fissure healing and prevention of anal incontinence involving division of the internal sphincter at two different levels. Methods: In comparative nonrandomized trial patients with chronic fissure in ano satisfying the inclusion and exclusion criteria were allocated to lateral sphincterotomy and segmental internal sphincterotomy groups. The outcome factors were perianal sepsis, pain relief using VAS as assessed on passing the first motion, duration of healing of fissure, assessment of incontinence using Wexner's continence score on 30 th post-operative day. Results: A total of 54 cases were enrolled, of them 31 patients underwent lateral internal sphincterotomy and 23 underwent segmental internal sphincterotomy with the mean age of patient was 34.76 years and a male to female ratio of 1.07:1. The pain score (VAS) on passing stool for the first time postoperatively was 4.5 with lateral sphincterotomy and 3.91 with segmental internal sphincterotomy which was statistically significant (P value < 0.010). The duration of postoperative healing was observed to be 27.94 days and 28.09 days in lateral sphincterotomy and segmental internal sphincterotomy group respectively. The post-operative anal incontinence was evaluated by using Wexner's continence grading after one month which was not statistically significant between two groups. Conclusions: Segmental internal sphincterotomy could be a good surgical modality with its healing effect on fissure in ano and post-operative complications which are similar to standard lateral internal sphincterotomy.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

A comparison of segmental internal sphincterotomy versus lateral internal sphincterotomy in management of chronic fissure in ano

et al. 2017

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“…Recurrence rate is 4-6% in difference studies. 17,18,19 But we did not received any patients with such complications it may be due to poor follow up.…”

Section: Discussionmentioning

confidence: 96%

A comparative study of the results of the lateral internal anal sphincterotomy vs manual dilatation of anus for chronic anal fissure.

Nawaz

Mahmood

Hayat

et al. 2020

TPMJ

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Objectives: To compare the results of surgical treatment of chronic anal fissure after lateral internal sphincterotomy with manual dilatation of anus. Study Design: Randomized Controlled Prospective study. Setting: Department of Surgery District Teaching Hospital Sargodha, Pakistan. Period: April 2018 to Feb 2019. Material & Methods: Patients were divided into two groups by lottery method. The procedures were performed using standard protocols after obtaining written informed consent. 50 patients underwent lateral internal anal sphincterotomy (Group 1) and 50 patients manual dilatation of anus (Group 2). Patients having atypical anal fissures associated with other diseases were excluded from this study. We assessed both groups for persistence of symptoms, complications and better satisfaction in terms of surgical techniques. Results: All patients became symptoms free within 07-14 days of surgery. Urinary retention was noted in 2(4%) patients in lateral internal sphincterotomy and 2(4%) in manual dilatation of anus. Temporary flatus Incontinence was noted in 2(4%) patient of lateral internal sphincterotomy and 2(4%) in manual dilatation of anus. Faecal soiling was observed in 1(2%) patient of lateral internal sphincterotomy. No recurrence, anal stenosis, hemorrhage, infection of wound, pain and bleeding associated with defecation was seen in both groups. Conclusion: Both lateral internal sphincterotomy and manual dilatation of anus techniques are effective.

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“…In cases of failure of LIS, patients should be assessed with anorectal manometry and endoanal ultrasound. If the amount of sphincter divided was inadequate, repeat internal sphincterotomy can be done, or contralateral LIS can be performed [95]. Patients' wishes should be taken into consideration for further management.…”

Section: Treatment Algorithmmentioning

confidence: 99%

Fissure-In-ANO

Fahadullah¹,

Peirce²

2018

Proctological Diseases in Surgical Practice

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This chapter provides a summary of the aetiology, diagnosis, investigation and management of anal fissure. It gives an overview of clinical anatomy and pathophysiology related to anal fissure. Focusing on anal sphincter hypertonia as the key factor for anal fissure progression, the chapter draws attention to perpetuating factors that contribute to a vicious cycle of fissure non-healing and addresses management options for these factors. This chapter also looks at the way how different treatment options for anal fissure emerged over time and uses evidence-based medicine to compare these options."Fissure-in-ANO" concludes with summarising the treatment options and suggesting an algorithm for management of acute and chronic anal fissures.

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Lateral internal sphincterotomy for surgically recurrent chronic anal fissure

Cited by 29 publications

References 37 publications

A comparison of segmental internal sphincterotomy versus lateral internal sphincterotomy in management of chronic fissure in ano

A comparison of segmental internal sphincterotomy versus lateral internal sphincterotomy in management of chronic fissure in ano

A comparative study of the results of the lateral internal anal sphincterotomy vs manual dilatation of anus for chronic anal fissure.

Fissure-In-ANO

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