OUTCOME OF CLOSE INTERNAL SPHINCTEROTOMY IN THE MANAGEMENT OF CHRONIC ANAL FISSURE

Abstract

Background: Chronic anal fissure is a common benign anorectal condition characterized by severe pain and bleeding during defecation. It often results from hypertonicity of the internal anal sphincter. Lateral internal sphincterotomy (LIS) remains the gold standard surgical treatment, though postoperative complications such as incontinence and infection may occur. Objective: To determine the outcomes of closed lateral internal sphincterotomy (LIS) in the management of chronic anal fissures. Study Design: Descriptive study. Setting: Department of General Surgery, Saidu Group of Teaching Hospital, Swat, Pakistan. Duration of Study: From 26-August-2024 to 26-February-2025. Methods: A total of 149 patients aged 18–60 years diagnosed with chronic anal fissure were included. Patients presented with symptoms lasting more than six weeks, including pain (VAS >4), bleeding, and clinical findings of sentinel piles or hypertrophied anal papillae. All underwent closed LIS under regional anesthesia using a von-Greaves knife, ensuring preservation of sphincter tone. Postoperative outcomes were monitored over four weeks and included bleeding (visible blood), wound infection (erythema, edema, purulent discharge), and flatus incontinence (involuntary passage of gas). Data were analyzed using SPSS version 25. Results: The mean patient age was 37.85 ± 12.36 years, with a slight male predominance (55.7%). Postoperative complications included bleeding in 7.4%, wound infection in 11.4%, and flatus incontinence in 22.8% of cases. Conclusion: Closed lateral internal sphincterotomy is a safe and effective surgical option for chronic anal fissures, demonstrating low rates of bleeding and wound infection, with transient flatus incontinence observed in a minority of cases.