LATERAL INTERNAL SPHINCTEROTOMY

Anal fissure is a common anorectal problem, presenting with pain during and after defecation. It is associated withincreased tone of the internal anal sphincter muscle. The relief of this hypertonia is the cornerstone of the treatment of the anal fissure. Thesurgical relief of this hypertonia is very successful in treating the fissure with minor morbidity of the procedure. Patients & M e t h o d s : A studywas conducted in 486 patients,(344-males and 142 females,25-40 range). Setting: Saad Surgi-med hospital Faisalabad. Period: 1999to 2007. Lateral internal anal Sphincterotomy for chronic anal fissure. The therapeutic outcome and complications of the procedure wererecorded. Results: Out of 486 patients, 344 were males and 142 females.frange 25-40) The site of fissure was in posterior midline 6 O' clockin 350 patients.(m=257,f=93);Anterior midline. 12 O'clock in 99 patients.(m=76,f=23);both anterior and posterior in 41 patients.(m=l 5,f=26)Eleven patients had associated peri-anal abscess and 19 patients had associated Fistula in ano. All the patients were discharged after 24hrs with regular follow up at 1,2,6,24 wks. 275 patients had significant relief of pain in 48 hrs, 107 became pain free in 1 wk.37 has had somepain for 2 wks. In 479 patients fissure healed in 3 months, 7 patients has had delayed healing out of which five patients required curettageof the wound under local anaesthesia which healed subsequently in next six wks. 12 patients had minor incontinence whichdisappeared in 4 wks. In one patient the incontinence persisted for six months then it got settled. Conclusion: Lateral subcutaneous internalSphincterotomy is a safe and effective treatment of chronic anal fissure.