Comparison between lateral sphincterometry and Lord’s operation in treatment of anal fissure

Authors

  • Yogesh V. Velani Department of Surgery, Gujarat Adani Institute of Medical Science, Bhuj, Kutch, Gujarat, India
  • Attman P. Velani Department of Surgery, Dr D Y Patil Medical College, Navi Mumbai, Maharashtra, India

DOI:

https://doi.org/10.18203/2349-2902.isj20191277

Keywords:

Sphincterometry, Lord’s operation, Treatment, Anal fissure

Abstract

Background: Two widely performed surgeries include Lord’s anal dilatation (LAD) and lateral internal sphincterotomy (LIS). LAD is one of the ancient and simple surgical techniques, but with high incidence of recurrence and incontinences. LIS is the preferred surgical technique these days, but again with high incidence of incontinence. Aim of this study was done to compare LAD with LIS in the treatment of anal fissure with regard to symptoms, post-operative complications and recurrence.

Methods: In the present study the age of patient was to be between 18–50 years, having CAF, all the patients having CAF not responded to the medical management for more than 6 weeks. The patients were randomly assigned to either group. Pre and post-operative pain was accessed using Wong-baker faces pain rating scale. Constipation was accessed by modified Longo score. Incontinence was accessed by scoring system reported by Wexner.

Results: When the Wong Bakers faces pain score was done there were 69% of patients with grade IV score and 31% had grade V pain score. The second most presenting complaint was of bleeding per rectum, it was found in 80% of the patients. For constipation the preoperative modified Longo score was 14. On examination sentinel tag was present in all the cases out of which 93% was posterior, 5% anterior and multiple in 2% cases.

Conclusions: A total of 200 patients were studied during the study. In this study, females were commonly affected than males. Constipation was the major predisposing factor among all cases 85%. Most of the fissures were located in the posterior midline 89%. Anterior fissures were slightly more common in females. It is our view that the role of pharmacological agents is likely to assume greater prominence in the future and that more effective agents and modes of delivery will be developed.

References

Fahadullah M, Peirce C. Fissure-In-ANO. Proctological Diseases in Surgical Practice: Intech Open. 2018.

Lieberman DA. Common anorectal disorders. Annals Internal Med. 1984;101:837-46.

Acuin J. Chronic suppurative otitis media: burden of illness and management options. 2004.

Ross CE, Mirowsky J. Neighborhood disadvantage, disorder, and health. J Health Soc Behav. 2001;42(3):258-76.

Kumar D, Negi A, Kumar N, Pandey A. A prospective, randomize study of comparison of lateral internal sphincterotomy versus Lord’s anal dilatation in chronic anal fissure. Int Surg J. 2018;5:1026-30.

Oh C, Divino CM, Steinhagen RM. Anal fissure. Diseases of the Colon Rectum. 1995;38:378-82.

Brisinda G, Civello IM, Albanese A, Maria G. Gastrointestinal smooth muscles and sphincters spasms: treatment with botulinum neurotoxin. Current Med Chem. 2003;10:603-23.

Chong PS, Bartolo DC. Hemorrhoids and fissure in ano. Gastroenterol Clin N Am. 2008;37:627-44.

Tocchi A, Mazzoni G, Miccini M, Cassini D, Bettelli E, Brozzetti S. Total lateral sphincterotomy for anal fissure. Int J Colorectal Dis. 2004;19(3):245-9.

Nash GF, Kapoor K, Saeb-Parsy K, Kunanadam T, Dawson PM. The long term results of Diltiazem treatment for anal fissure. Int J Clin Pract. 2006;60(11):1411-13.

Gerald A. Isenberg. Anal Fissure. Clin Colon Rectal Surg. 2011;24(1):22-30.

Downloads

Published

2019-03-26

Issue

Section

Original Research Articles