CHRONIC ANAL FISSURE

Compare lateral anal sphincterotomy (closed method) with anal dilatation in the management of primary chronicanal fissure. Study design: A prospective, comparative, interventional study. Place and duration: Department of Surgery Combined MilitaryHospital Kohat from Jan 2001 to Mar 2002.Materials and Methods: During the period, all patients with primary type of chronic anal fissure, whowere 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 arandomized manner. After their respective surgical procedures patients were followed up for four weeks on weekly basis. The changes in signsand 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 fissurewas 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 ofulcer. Those operated by AD, there was disappearance of all the symptoms and complete healing of ulcer in only 8 (38%) patients. Incontinencewas present in 9 (18.36%) patients. Three (14.2%) patients had persistence of ulcer while one (4.76%) was having recurrence ofulcer.Conclusion: Lateral anal sphincterotomy, especially close method gives excellent results as compared to anal dilatation in terms of ulcerhealing, disappearance of symptoms and lower rate of ulcer recurrence or incontinence.