Farhat Jaleel, Lubna Habib, Masoom Raza Mirza.
Outcome of conservative lateral internal Anal Sphincterotomy for chronic anal fissure.
J Surg Pak Jan ;13(4):159-62.

Objective To determine the effectiveness of conservative lateral internal anal sphincterotomy in the treatment of chronic anal fissure in females. Study design: Quasi-experimental study. Place & Duration of study: Hamdard University Hospital and three other private city hospitals of Karachi, from January 2006 to December 2007. Patients and Methods All female patients with wide based fissures with fibrosis, large skin tags and recurrence/failure of healing after chemical sphincterotomy were included. Patients were operated under spinal anaesthesia in lithotomy position. Lateral internal anal sphincterotomy was done up to 1cm at 9o clock position and skin tags were excised. Data and results were recorded on predesigned proforma and outcome in terms of pain relief, healing, complications and recurrence were recorded. Results: Total number of patients was 67. Mean age was 31 years. Duration of symptoms was between 2 months to more than 10 years. Fissures were associated with constipation in 52(77.6%) patients and onset dated back to the time of child birth in 39(58.2%) cases. Pain relief was achieved within 48 hours in 82% patients and complete healing of fissure occurred in 97.01%. Two patients had transient incontinence of flatus and mucous. One patient developed wound infection and two had recurrence of symptoms after one year of complete healing. Conclusions Conservative lateral internal anal sphincterotomy is a safe and effective method to treat chronic anal fissure with low rate of complications and recurrence.

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