FREQUENCY OF POST-OPERATIVE FAECAL INCONTINENCE IN PATIENTS WITH CLOSED AND OPEN INTERNAL ANAL SPHINCTEROTOMY
AbstractBackground: Fissure in ano is one of the commonest benign and painful proctologic diseases causing considerable morbidity and reduction in quality of life. There are medical as well as surgical treatment options for anal fissure. The study was conducted to compare the frequency of postoperative faecal incontinence in patients with closed lateral internal anal sphincterotomy with von-greaves knife versus standard Park’s operation (open method) for chronic anal fissure. Methods: This was a randomized controlled trial (RCT) was conducted at the Department of Surgery, KVSS, S.I.T.E. Hospital, Karachi, for a period of six months from 13th February to 12th August 2011. Ninety four consecutive patients having chronic anal fissure were assigned through blocked randomization to groups A & B, with 47 patients in each group. Closed lateral internal anal sphincterotomy (CLIAS) via von-greaves knife was carried out in patients of group-A whereas patients of group-B were subjected to open internal anal sphincterotomy (OIAS) also known as Parks’ procedure. Faecal incontinence was noted on the 5th post-operative day. Data was analysed using SPSS 16. Results: There were 81 (86.2%) males and 13 (13.8%) females with male to female ratio being 6:1. Mean age was 38.38 mp±14.56 years. Post-operative faecal incontinence in patients undergoing CLIAS was 4.3% while it was 21.3% in those undergoing OIAS with a p-value of 0.027. CLIAS with von-greaves knife is effective in reducing faecal incontinence on 5th postoperative day as compared to standard OIAS. Conclusion: CLIAS with von-greaves knife is effective in reducing faecal incontinence on 5th postoperative day as compared to OIAS (Park’s procedure). Therefore, this technique may be used in future regularly to treat chronic anal fissure for prevention of this morbidity.
Bhardwaj R, Parker MC. Modern perspectives in the treatment of chronic anal fissures. Ann R Coll Surg Engl 2007;89(5):472–8.
Sajid MS, Hunte S, Hippolyte S, Kiri VA, Maringe C, Baig MK. Comparison of surgical vs chemical sphincterotomy using botulinum toxin for the treatment of chronic anal fissure: a meta-analysis. Colorectal Dis 2008;10(6):547–52.
Hashmi F, Memon MM, Khan AM. Efficacy and side effects of glyceryl trinitrate in management of chronic anal fissure. J Ayub Med Coll Abbottabad 2012;24(1):21–2.
Poh A, Tan KY, Seow-Choen F. Innovations in chronic anal fissure treatment: A systematic review. World J Gastrointest Surg 2010;2(7):231–41.
Ram E, Alper D, Stein GY, Bramnik Z, Dreznik Z. Internal anal sphincter function following lateral internal sphincterotomy for anal fissure: a long-term manometric study. Ann Surg 2005;242(2):208–11.
Liratzopoulos N, Efremidou EI, Papageorgiou MS, Kouklakis G, Moschos J, Manolas KJ, et al. Lateral subcutaneous internal sphincterotomy in the treatment of chronic anal fissure: our experience. J Gastrointestin Liver Dis 2006;15(2):143–7.
Hashmat A, Ishfaq T. Chemical versus surgical sphincterotomy for chronic fissure in ano. J Coll Physicians Surg Pak 2007;17(1):44–7.
Jaleel F, Habib L, Mirza MR. Outcome of conservative lateral internal anal sphincterotomy for chronic anal fissure. J Surg Pak Int 2008;13:4.
Ahmed SA, Ahmed SA, Pervaiz NA, Naseem RI. Closed lateral internal anal sphincterotomy for anal fissure with von-greaves (cataract) knife. Pak J Surg 2008;24:220–3.
Hoffmann DC, Goligher JC. Lateral subcutaneous internal sphincterotomy in treatment of anal fissure. Br Med J 1970;3(5724):673–5.
Bakshi G, Ranka S, Agarwal S, Shetty SV. Modified mesh rectopexy: a study. J Postgrad Med 2000;46(4):265–7.
Pfenninger JL, Zainea GG. Common anorectal conditions: Part II. Lesions. Am Fam Physician 2001;64(1):77–88.
Rakinic J. Anal fissure. Clin Colon Rectal Surg 2007;20(2):133–7.
Farouk R, Monson JRT, Duthie GS. Technical failure of lateral sphincterotomy for the treatment of chronic anal ﬁssure: a study using anal ultrasonography. Br J Surg 1997;84(1):84–5.
Danish KF, Chaudhry AR, Khan SS. Intractable headache as a side effect of topical nitroglycerine ointment. Rawal Med J 2008;33(1):15–7.
Ali M, Akhtar R, Mirza TI. Chronic anal fissure; comparison of lateral anal sphincterotomy (closed method) versus anal dilatation. Professional Med J 2011;18(2):215–21.
Hyman NH, Cataldo PA. Nitroglycerin ointment for anal fissures: effective treatment or just a headache? Dis Colon Rectum 1999;42(3):383–5.
Sharp FR. Patient selection and treatment modalities for chronic anal fissure. Am J Surg 1996;171(5):512–5.
Denoya P, Sands DR. Anorectal physiologic evaluation of constipation. Clin Colon Rectal Surg 2008;21(2):114–21.
Sánchez Romero A, Arroyo Sebastián A, Pérez Vicente F, Serrano Paz P, Candela Polo F, Tomás Gómez, et al. Open lateral internal anal sphincterotomy under local anesthesia as the gold standard in the treatment of chronic anal fissures. A prospective clinical and manometric study. Rev Esp Enferm Dig 2004;96(12):856–63.
Garcia-Aguilar J, Belmonte C, Wong WD, Lowry AC, Madoff RD. Open vs. closed sphincterotomy for chronic anal fissure: long-term results. Dis Colon Rectum 1996;39(4):440–3.
Ticmeanu F, Berevoescu NI. [Treatment of chronic anal fissure using closed internal and lateral sphincterotomy]. Chirurgia (Bucur) 2005;100(2):133–7.
Vaizey CJ, Carapeti E, Cahill JA, Kamm MA. Prospective comparison of faecal incontinence grading systems. Gut 1999;44(1):77–80.