A PROSPECTIVE RANDOMISEDSTUDY COMPARINGLATERAL INTERNAL SPHINCTEROTOMY AND ANAL DILATATIONFOR THE MANAGEMENT OF CHRONIC ANAL FISSURE

Background: Lateral internal sphincterotomy (LIS) is a surgical procedure which is performed routinely in the treatment of chronic anal fissures, especially in cases that have failed traditional medical modalities. Controlled application of a Parks retractor was found to be an alternative method8,9 and with standardization, 88% healing 10 with a 12% recurrence were achieved in a large series. In this retrospective study, we compared intermittent dilation using Parks dilator with a standard LIS method to see the effect on chronic fissures management. Aims and objectives:Both anal dilatation and internal anal sphincterotomy are practiced in our hospital for treatment of chronic anal fissure, The objectives of the study was to compare the two procedures especially regarding pain relief,ulcer healing,incontinence and recurrence . Materials and methods:This study was carried out at Maharani Laxmi Bai Medical College, Jhansi, Uttar Pradesh from october 2020 to September 2021 on a pool of 100 patient out of which, 50 underwent anal dilation using Parks dilator (AD) and 50 underwent LIS. AD patients were discharged on the same day while LIS patients were discharged on post op day 2. Approval for the study was obtained fromthe ethical committee of the college. Results: 100 patients were studied and followed up.Pain was present in all the 100 (100%) patients and bleeding in 81 (82.6%) patients. Average duration of symptoms was 11.16 ± 12.17 (range, 1.8-60 months) and the difference between two groups was not significant. No patient had significant intraoperative complications. Four patients in LIS group complained of pain and some discharge on the fifth post-operative day.The average follow-up was 9 months. Pain relief was observed in 30 (Group A) and 35 (Group B) patients by the end of 1 week and 45 (Group A) and 50 (Group B) patients by the end of 1 month. By one month, healing of the ulcer was observed in 35 and 38 patients in group A and B respectively. By the end of 3 months, minor incontinence including mucous discharge was observed in 18 and 6 patients in group A and B respectively and the difference was significant (p=0.0062). True fecal incontinence occurred only in 2 patients in group A and was minor. No patient had major incontinence. A few among these patients who followed up till late, incontinence was found to gradually improve. Regarding recurrence, over the period of 9 months follow-up, 9 and 2 patients in group A and group B respectively reported with recurrence of symptoms and the fissure was evident on examination also (p =0.0075) Conclusions Both AD and LIS provides early pain relief and high ulcer healing rate. However, LIS appears to be safer with regard to incontinence, and the chance of recurrence is also lower compared to AD.