Fida Ahmed, Muhammad Azam Mengal, Manzoor Ahmed, Shakeel Akbar, Bilal Elahi, Alamgeer Khan.
Comparison of Complication of Open versus Closed Lateral Internal Sphincterotomy in Chronic Anal Fissure.
Pak J Med Health Sci Jan ;12(3):1072-4.

Aim: To compare the complications of open lateral internal sphincterotomy (OLIS) with closed lateral internal sphincterotomy (CLIS) in patients of chronic anal fissure (CAF). Methods: In this prospective, randomized clinical study, one hundred (100) patients of CAF who underwent open (n=50) or closed ( n=50) lateral internal sphincterotomy at Bolan medical complex hospital Quetta from Jan-2016 to July 2017 were analyzed. Post-op pain severity at 12 and 24 hours after surgery, fecal incontinence at 5th post-op day and hospital stay were the main outcome parameters. Results: The mean age was 39.12 +/-12.34 years in CLIS group patients and 41.40 +/-11.6 years in OLIC group patients. Pain during defecation was the commonest presenting symptom in both of the study patients. In CLIS group, 94% patients were having CAF on posterior side and 92% in OLIS group having it on posterior side. Intensity of pain after 12 hours of surgery was less in CLIS group, 5.76 +0.91 versus 6.45 +/-0.79 on OLIS group (p- value <0.0001). Similarly after 24 hours of surgery pain score was 2.00 +/-0.29 in CLIS group and 2.39 +/-0.61 in OLIS group (p-value <0.0001). Hospital stay duration was 2.36 +/-1.41 days in CLIS patients and 3.32 +/-2.23 in OLIS patients (p-value 0.01). Incidence of fecal incontinence was only 6.0% in CLIS group and 18.0% in OLIS group (p- value 0.06). Conclusion: Closed lateral internal sphincterotomy (CLIS) is superior to open lateral internal sphincterotomy (OLIS) for the surgical management of chronic anal fissure (CIF).

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