Closed lateral internal sphincterotomy using endoshere cut scissors.

ABSTRACT

BACKGROUND: Internal sphincterotomy remains the gold standard for treatment of chronic anal fissure but it is associated with immediate wound bleeding and hematoma, which is usually corrected by a pressure dressing for half an hour. OBJECTIVE: This procedure was the initial study to decrease intra-operative and immediate postoperative wound bleeding, hematoma, and duration of pressure by using Endoshere cut scissors for closed lateral internal sphincterotomy. MATERIAL AND METHOD: Closed lateral internal sphincterotomy was performed on patients with chronic anal fissures by using Endoshere cut scissors in standard technique. The Fansler's proctoscope (diameter 1.5 cm) was inserted into the anal canal to permit adequate exposure of the anal fissure after local anesthetized with 0.5% xylocaine with adrenaline 1-2 cc. at left lateral region. The intersphincteric groove was identified, and then the small stab incision was made on the lateral side. The surgeon used the forceps to expose the internal sphincter then sphincterotomy was carried out with Endoshere cut scissors. After the operation was finished, no pressure dressing was applied to the sphincterotomy wound. RESULTS: Closed lateral internal sphincterotomy was performed on 10 patients by using Endoshere cut scissors. The present results showed that no intra-operative and immediate postoperative wound bleeding, hematoma occurred. No pressure dressing was required. CONCLUSION: The authors' early results showed that Endoshere cut scissors are usefulfor closed lateral internal sphincterotomy. There was no intra-operative and immediate postoperative wound bleeding and hematoma. The pressure dressing is unnecessary. The long term results should be further studied in a randomized control trial.