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).