Conservative closed lateral internal sphincterotomy: local or general anaesthesia?

ABSTRACT

A prospective randomised study was carried out to compare conservative closed lateral internal sphincterotomy [CLIS] under general and local anaesthesia. Sixty patients with chronic anal fissure were randomised and equally subdivided into two groups. Local anaesthesia group GLIS under local anaesthesia [LA] [mean age 31.6 years]. General anaesthesia group CLIS under general anaesthesia [GA] [mean age 30.4 years]. Both groups were comparable regarding the age, sex, weight and duration of symptoms. There were no differences between the two groups in terms of actual time of surgery, mean pulse rate and mean oxygen saturation. However, there was a significant difference in the mean arterial pressure between the two groups. CLIS under LA was a shorter procedure as compared to GA. General anaesthesia was associated with postoperative nausea and vomiting in 20% of the patients. Postoperative analgesia requirements were greater in the GA group than in the LA group. Haematoma occurred in one patient in the general anaesthesia group. During the one-year interval of follow-up, healing of the fissure was 100% in both groups. The incidence of sphincter dysfunction and recurrence was similar in both groups [0%]. No other complications, like perianal fistula, were found during the follow-up period. The majority of patients expressed satisfaction with LA. Conservative closed lateral internal sphincterotomy under local anaesthesia is a simple, safe and effective procedure. Careful patient selection and meticulous surgical technique are necessary to achieve a very high success rate and a negligible rate of complications