Posted in Volume 15 - Number 3
KAMRAN RAHIM, MUJAHID ALI KHOSO, TOQEER NASIR, ZAKAULLAH KHAN, FARHAN MAJEED
ABSTRACT | Full Text PDF
OBJECTIVES To compare open and closed techniques of lateral internal sphincterotomy in terms of pain relief and post operative complications.
DESIGN: It was a prospective, quasi-experimental study.
PLACE AND DURATION OF THE STUDY Surgical department, Combined Military Hospital Quetta. From May 2007 to April 2008
SUBJECTS AND METHODS: Sixty patients with chronic anal fissure were included in the study after taking informed consent. Thirty patients were randomized into each group (A & B). Group ‘A’ patients were treated by open while those in Group ‘B’ were treated by the closed technique under general anesthesia (GA) or caudal anesthesia. Patients were discharged and called/ contacted for follow up after two weeks, six weeks and six months.
RESULTS: Sixty patients (48 males and 12 females), aged 20 to 48 years with chronic anal fissure had lateral internal sphincterotomy. Satisfactory pain relief (more than 50% reduction) was equivalent, 28 (93.33%) in Group A compared to 27 (90%) in Group B. Immediate/ early complications were equivocal as only one patient with open technique developed post operative hemorrhage and one with closed sphincterotomy had hematoma formation. There were no cases of infection/ abscess formation. Among late complications, recurrence was slightly more common in closed sphincterotomy (2/30 compared to 1/30), while there was a slightly higher incidence (3/30 compared to 2/30) of incontinence in open technique. Overall new onset incontinence was however significant (5/60 or 8.33%). None developed postoperative fistulae.
CONCLUSION: There is no significant difference between open and closed lateral internal sphincterotomy in terms of symptomatic relief and postoperative complications in patients of chronic anal fissure.
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