ABSTRACT
Introduction: Chronic idiopathic fissure-in-ano is one of the common and important anal lesions encountered in surgical practice. For effective treatment reduction in the tone of the internal anal sphincter is the key to success. Of the procedures developed to reduce the sphincteric tone, a lateral internal anal sphincterotomy is widely used. It can be done in two methods, i.e., open lateral internal anal sphincterotomy (OLIS) and closed lateral internal anal sphincterotomy (CLIS). Aims: The aim of the study is to prospectively evaluate and compare the efficacy of CLIS and OLIS with respect to immediate postoperative complications, relief of pain, the incidence of disturbances in anal continence, healing of fissure and duration of hospital stay. Settings and Design: Prospective study, approved by the ethical committee, was undertaken in the surgery ward at a tertiary level teaching hospital of Karnataka Institute of Medical Sciences, Hubli. Materials and Methods: A total of 59 patients attending the Outpatient Department of Karnataka Institute of Medical Sciences, Hubli, for treatment of chronic fissure in ano between November 2015 and September 2017 were enrolled and prospectively evaluated in this study. 30 patients underwent OLIS and 29 patients underwent CLIS. They were followed up for 3 months postsurgery. Data were collected using the pro forma and were statistically analyzed. Results: A total of 59 patients were included in the study with 31 being male and 28 female patients. Chronic fissure-in-ano was commonly seen in the middle age group with the mean age of presentation of 35.69 ± 13.21 years, with 43 of the cases occurring between 18 and 40 years (73%). 78% of patients had pain during defecation and bleeding PR as their chief complaints. The mean duration of symptoms was 26.33 ± 16.93 months and varied from 6 months to 120 months. On examination, posterior midline fissure with sentinel pile (76%) was most common finding followed by anterior midline fissure (12%) and both anterior and posterior midline fissures with sentinel pile (12%). 30 patients (51%) underwent OLIS and 29 patients (49%) underwent CLIS at random under spinal anesthesia. 41 patients (69.49%) had an uneventful recovery. 12 patients (20%) had post-operative complications in OLIS group, and 6 patients (20.7%) developed post-operative complications in CLIS group. Post-operative bleeding noted in 10% of cases in OLIS group against 3.4% in CLIS group. Infection developed in 16.7% of the cases in OLIS group as compared to 10.4% in CLIS group. Postoperative pain was significantly less in CLIS group than in OLIS group. As far as disturbances of anal continence are concerned OLIS group had a higher incidence of disturbance 13.3% as against 6.9% in the CLIS group. Fissure healing was 100% in both the groups. 12 patients were discharged on day 1 in CLIS group against only 5 in OLIS group, indicating less duration of hospital stay in CLIS group. Conclusions: After these observations and findings it is apparent that closed method of sphincterotomy (CLIS) had significantly less post-operative pain, had a lesser incidence of post-operative complications with significantly lesser disturbances in the anal continence mechanism and lesser duration of hospital stay when compared to open method of sphincterotomy (OLIS).
ABSTRACT
Introduction: Inguinal hernia repair is one of the most commonly performed surgeries in the world. The surgeon today has the liberty to select from a wide variety of prosthetic meshes. Whether the newer meshes can replace the time-tested Lichtenstein mesh repair is a subject of ongoing debate. Objectives: To determine the feasibility of using the Prolene Hernia System (PHS) and to compare it with Lichtenstein repair for open tension-free repair of inguinal hernias. Materials and Methods: Lichtenstein mesh repair and PHS repair were performed on 60 inguinal hernias in 55 patients in KIMS, Hubli. All these patients were followed up for a period of 2-year. Results: The mean age of the population in PHS group is 49.90 ± 15.93 years and in Lichtenstein group is 50.63 ± 1.19 years. The mean duration of surgery in PHS group is 46.67 ± 6.48 min and in Lichtenstein group is 46.33 ± 7.18 min (P > 0.05). Most of the surgeries were completed between 41 and 50 min. The mean duration of post-operative hospital stay in PHS group is 3.63 ± 1.22 days and in Lichtenstein group is 4.10 ± 2.25 days (P > 0.05). 1 (3.3%) patient in PHS group and 2(6.7%) patients in Lichtenstein group had seroma (P > 0.05). 1 (3.3%) patient each in PHS group and in Lichtenstein group had wound infection (P > 0.05). 2 (6.7%) patients in PHS group and 3 (10%) patients in Lichtenstein group had groin pain which lasted for >3 months (P > 0.05). None of the patients in both the groups had recurrence till the time of publication of results. Conclusion: Lichtenstein mesh repair continues to be an effective means for treating inguinal hernia with minimal complications. PHS mesh repair is a suitable alternative to the time-tested Lichtenstein mesh with comparable outcomes and can be suggested in affordable patients as it eliminates the possibility of all types of hernia.