CHRONIC ANAL FISSURE

Objective: To compare lateral anal sphincterotomy (closed method) with anal dilatation in the management of primary chronic anal fissure. Study design: A prospective, comparative, interventional study. Place and duration: Department of Surgery Combined Military Hospital Kohat from Jan 2001 to Mar 2002.Materials and Methods: During the period, all patients with primary type of chronic anal fissure, who were above 12 years of age and were fit for surgery, were selected for study. They were divided into two groups for both surgical procedures in a randomized manner. After their respective surgical procedures patients were followed up for four weeks on weekly basis. The changes in signs and symptoms were thoroughly reassessed and noted in a separate proforma maintained for each patient for the purpose of comparison. Results: The total number of patients was 49 with an average age of 40 years. Male to female ratio was 7:1. In 44 (89.79%) patients the fissure was located posteriorly while in 5 (10.20%) patients it was located anteriorly. Closed lateral anal sphincterotomy (LAS) was done in 28 (57.14%) patients, of which 25 (51.02%) were males and 3 (6.12%) females. While anal dilatation (AD) was done in 21 (42.85%) patients, 18 (36.73%) males and 3 (6.12%) females. In all the patients in whom LAS was done, there was disappearance of all the symptoms and complete healing of ulcer. Those operated by AD, there was disappearance of all the symptoms and complete healing of ulcer in only 8 (38%) patients. Incontinence was present in 9 (18.36%) patients. Three (14.2%) patients had persistence of ulcer while one (4.76%) was having recurrence of ulcer.Conclusion: Lateral anal sphincterotomy, especially close method gives excellent results as compared to anal dilatation in terms of ulcer healing, disappearance of symptoms and lower rate of ulcer recurrence or incontinence.