Comparative study of manual anal dilatation with fissurectomy versus lateral anal sphincterotomy in chronic fissure in ano
Journal Title: MedPulse -International Medical Journal - Year 2016, Vol 3, Issue 2
Abstract
Introduction: Anal fissure is a distinct clinic pathological condition of the lower anal canal. It can be defined as a longitudinal ulcer in the anoderm usually in the posterior midline, less frequently in the anterior midline, and rarely in the lateral position of the anal canal. When traction is applied on each side of the anus, the fissure appears to be triangular in shape, with the apex near the dentate line and the base over the lower anal canal. Aims and Objectives: To Study Manual Anal Dilatation With Fissurectomy Versus Lateral Anal Sphincterotomy In Chronic Fissure In Ano Methodology: This was A prospective study carried out at Department of General Surgery Aarupadai Veedu Medical College and Hospital form October 2013 to August 2015. Patients with chronic anal fissure from all surgical units (S1 to S4) who were not responding to conservative management were studied total 120 patients were included into study. Result: 88 patients (73.3%) of the total 120 patients underwent lateral sphincterotomy (LAS). 32 patients (26.67%) of the total 120 patients underwent manual anal dilatation with fissurectomy (MAD+F). patients (5%) were below 20 years. 82 patients (68.33%) were between 20 and 39 years. 32 patients (26.67%) were above 40 years. 52 patients (43.33%) were males. 68 patients (56.67%) were females. 32 patients of 120(26.67%) had an associated haemorrhoids. 2 patients of 120 had a fistula-in-ano54 patients of 120 ( 45%) complained of persistent pain. Remaining 66 had no pain. Of the 54 who had pain, 30 patients ( 34% out of 88 ) belonged to lateral sphincterotomy group and 24 patients ( 75% out of 32 ) belonged to the fissurectomy group28 patients of 120 (23.33% ) complained of persistent bleeding. Remaining 92 had no bleeding. Of the 28 who had bleeding, 19 patients (21.6% out of 88) belonged to the sphincterotomy group and 9 ( 28.13% out of 32 ) belonged to the fissurectomy group. 30 patients (25% ) of the 120 developed urinary retention. Of them, 18 (20.45% out of 88) belonged to the sphincterotomy group and 12 (37.5% out of 32) belonged to the fissurectomy group. Conclusion: It can be concluded that given the lower rate of complications but for the higher chances of pain, manual anal dilatation with fissurectomy might be considered as an alternative procedure in the surgical management of chronic anal fissures. However, much remains to be done regarding its long term results through more extensive and larger clinical trials
Authors and Affiliations
Shantha Mohan NP, R Chandrasekar, Venkateshwarlu Chetty
Keywords
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