Muhammad Khalid, Faisal Bilal Lodhi, Tariq Farooq, Riaz Hussain.
Chronic Fissure-in-Ano; Lateral internal Sphincterotomy vs Manual dilatation of Anus.
Professional Med J Jan ;11(2):141-5.

Aims and Objectives: (1) To compare the effectiveness of manual dilatation of anus and lateral internal sphincterotomy in chronic anal fissure. (2) To calculate the complications rate i.e. incontinence, and recurrence of disease in two procedures. Setting: Allied/ DHQ Hospitals (PMC) Faisalabad. Period: From August 1999 to September 2001. Design: A prospective randomized study. Materials and Methods: Consecutive forty patients (Male-26, Female-14) irrespective of age and sex were included in this trial, after taking written informed consent. The diagnosis of chronic fissure-inano was made on the basis of typical clinical features. The diagnosis was confirmed on examination under anaesthesia (EUA). Sigmoidoscopy was done in all cases to look for evidence of any associated disease. Biopsy of the fissure was taken to sort out the aetiological factors like tuberculosis, Crohn`s disease and carcinoma. Randomization: Patients having odd serial number were treated by manual dilatation of anus and patients having even serial numbers were dealt with by lateral internal sphincterotomy either under spinal or general anaesthesia. A follow-up was done for 3,6 and 12 weeks. Technique: Patients having chronic fissure-in-ano were admitted in the ward from outpatient department. MDA was performed as described by Watts et al. Lateral internal sphincterotomy was always performed on the left lateral side with the patient in the lithotomy position. Patients were followed-up regularly at intervals of 3,6 and 12 weeks. At follow-up, symptoms were assessed on a pre-designed questionnaire. Statistical evaluation was done by t-test. Conclusion: Lateral internal sphincterotomy is the treatment of choice in patients with chronic fissure-in-ano resistant to conservative measures. It has no permanent side effects and is well tolerated.

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