Evaluation of the results of patients who had undergone lateral internal sphincterotomy due to chronic anal fissure: analysis of 281 cases

Abstract

Introduction and purpose: Pharmacological and surgical treatment options are available for the treatment of chronic anal fissure (CAF). Pharmacological treatments include treatment modalities such as glyceryl trinitrate, calcium channel blockers and alpha-adrenoreceptor antagonists. Surgical treatment options include anal dilatation and sphincterotomy, and among many sphincterotomy procedures open lateral internal sphincterotomy (open LIS) is now considered the gold standard. The aim of this study was to investigate the demographic data, complaints, early and late complications of patients who have undergone LIS due to chronic anal fissure and to contribute to the literature. Material and method: Data of 281 patients who have undergone open LIS operation between 2013-2018 due to chronic anal fissure that did not respond to conservative treatment were analyzed retrospectively. Age, gender, complaint (pain, bleeding, constipation, itching), follow-up period and postoperative complication (infection, bleeding, pain, fistula, gas or stool incontinence) data of the patients were evaluated retrospectively. Patients with gas or fecal incontinence were evaluated with Wexner incontinence score. Results: Out of 281 patients, 197 were female (70.1%), 84 were male (29.9%). Female / male ratio was 2.34. The mean age was 40.31 ± 13.59 (min 18-max 84) years. The mean follow-up period was 24.53 (min 6 - max 67) months. In 248 (88.3%) patients, pain was noted during defecation, while bleeding was noted in 208 (74%) patients, constipation was noted in 133 (47.3) patients and perianal itching was noted in 91 (32.4%) patients. In 7 (2.5%) patients, infection occurred at the site of operation. Perianal fistula was seen in one patient (0.4%), recurrence was seen in 12 (4.3%), transient gas incontinence was seen in 4 (1.8%) and fecal incontinence was seen (0.35%) in 1 patient. Seven patients who had developed infection responded to oral antibiotic treatment and none of them developed abscesses. Result: As a result, open LIS operation is an efficient and effective surgical treatment method for the treatment of CAF.