A comparative study of bilateral lsias verses conservative management in acute anal fissure

Authors

  • Harpreet Kaur Department of General Surgery, SGT University, Gurgaon, Haryana, India
  • M. S. Ray Department of General Surgery, SGT University, Gurgaon, Haryana, India
  • S.S. Malhi Department of General Surgery, SGT University, Gurgaon, Haryana, India
  • Digpal Thakore Department of General Surgery, SGT University, Gurgaon, Haryana, India
  • Naresh Modi Department of General Surgery, SGT University, Gurgaon, Haryana, India

DOI:

https://doi.org/10.18203/2349-2902.isj20221145

Keywords:

Anal fissure, LSIAS, Sphincterotomy

Abstract

Background: Anal fissure is a tear in anal canal just below dentate line. It can be acute or chronic. In most patients, it is located in posterior midline. Its treatment is both conservative and surgical. In conservative management, there are no clear guidelines and its goal is to break the cycle of anal sphincter spasm allowing improved blood flow to fissured area for healing. Surgery is considered for patients not responding to conservative measures and its gold standard is lateral internal sphincterotomy.

Methods: This prospective study was conducted among 60 patients with acute anal fissure. Patients were randomly divided into two study groups based on treatment protocols conservative management and Bilateral LSIAS. Prior informed written consent was obtained. Demographic profile, history, investigations, diagnosis, treatment and follow-up data was recorded and analyzed.

Results: Patients with Bilateral LSIAS got pain relief immediately after surgery. 57% patients with conservative management reported head-ache and perianal itching. Over 86% of patients with Bilateral LSIAS got relief from pain and discomfort after treatment; around over 46% patients with conservative approach, had pain and discomfort after 6 weeks of treatment.

Conclusions: Results show that Bilateral LSIAS surgery is a better approach than conservative management of anal fissure. Further, the Bilateral LSIAS surgery has maximum chances of early recovery and pain relief and reduced chances of progression to chronic anal fissure. Hence, we can conclude that for anal acute fissure, Bilateral LSIAS surgery procedure is the treatment of choice.

References

Keck JO, Staniunas RJ, Coller JA, Barrett RC, Oster ME. Computer-generated profiles of the anal canal in patients with anal fissure. Dis Colon Rectum. 1995;38:72-9.

Schouten WR, Briel JW, Auwerda JJ. Relationship between anal pressure and anodermal blood flow. The vascular pathogenesis of anal fissures. Dis Colon Rectum. 1994;37:664-9.

Klosterhalfen B, Vogel P, Rixen H, Mittermayer C. Topography of the inferior rectal artery: a possible cause of chronic, primary anal fissure. Dis Colon Rectum. 1989;32:43-52.

Schouten WR, Briel JW, Auwerda JJ, De Graaf EJ. Ischaemic nature of anal fissure. Br J Surg. 1996;83:63-5.

Zaghiyan KN, Fleshner P. Anal fissure. Clin Colon Rectal Surg. 2011;24:22-30.

Madalinski MH. Identifying the best therapy for chronic anal fissure. World J Gastrointest Pharmacol Ther. 2011;2:9-16.

Wald A, Bharucha AE, Cosman BC, Whitehead WE. ACG clinical guideline: management of benign anorectal disorders. Am J Gastroenterol. 2014;109:1141-57.

Hananel N, Gordon PH. Re-examination of clinical manifestations and response to therapy of fissure-in-ano. Dis Colon Rectum. 1997;40(2):229-33.

Jiang JK, Chiu JH, Lin JK. Local thermal stimulation relaxes hypertonic anal sphincter: evidence of somatoanal reflex. Dis Colon Rectum. 1999;42:1152-9.

Nelson RL, Thomas K, Morgan J, Jones A. Non surgical therapy for anal fissure. Cochrane Database Syst Rev. 2012;2:CD003431.

Garavoglia M, Borghi F, Levi AC. Arrangement of the anal striated musculature. Dis Colon Rectum. 1993;36(1):10-5.

Metcalf AM, Dozois RR, Kelly KA. Sexual function in women after proctocolectomy. Ann Surg. 1986;204(6): 624-7.

Courtney H. Anatomy of the pelvic diaphragm and anorectal musculature as related to sphincter preservation in anorectal surgery. Am J Surg. 1950;79(1):155-73.

Tahbaz SH, Poorsaadati S, Radkani B, Forootan M. Psychological disorders in patients with chronic constipation. Gastroenterol Hepatol Bed Bench. 2011;4:159-63.

Leong APK. The pharmacological treatment of anal fissures A future role in the primary care. Singapore Med J. 2003;44(3):136-7.

Gupta PJ. The treatment of fissure in ano- revisited. Afr Health Sci. 2004;4(1):58-62.

Golfam F, Golfam P, Khalaj A, Mortaz SS. The effect of topical nifedipine in the treatment of chronic analfissures. Acta Medica Iranica. 2010;48(5):295-9.

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Published

2022-04-26

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Original Research Articles