Volume : VII, Issue : I, January - 2018

Study of Lateral Sphincterotomy in the Treatment of Chronic Fissure in Ano

Dr Jagdish B Karia, Dr Rutik Gandhi, Dr Ketul Shah

Abstract :

 

Anal fissures are considered one of the commonest causes of severe anal pain. An anal fissure is a longitudinal tear or ulcer in the distal anal canal. It is usually located in the posterior or anterior midline and extends from the level of dentate line to the anal verge. Acute fissure is one which presents within 3–6 weeks of symptom onset. It has the appearance of a clean longitudinal tear in the anoderm with little surrounding inflammation. Acute fissure usually heals spontaneously within 6 weeks. A chronic fissure, with more than 6 weeks of symptoms, is usually deeper and generally has exposed internal sphincter fibers in its base. It is frequently associated with a hypertrophic anal papilla at its upper aspect and sentinel pile at its distal aspect. Based on etiology it is classified as primary (idiopathic) or secondary. Secondary fissures are those that occur due to some other pathology such as Crohn’s disease, anal tuberculosis, AIDS. Patients usually present with pain during defecation and passage of ight red blood per anus. The precise etiology of anal fissure is unknown. Fissure is most commonly attributed to trauma from the passage of a large hard stool, but it is also seen after acute episodes of diarrhea. Painful fissures are generally associated with involuntary spasm of the internal sphincter with high resting pressure in the anal canal. So, it seems that chronic over activity of the internal sphincter may be the cause. Reduction of anal sphincter spasm results in improved blood supply and healing of fissure. Surgical techniques like manual anal dilatation or lateral internal sphincterotomy, effectively heal most fissures within a few weeks [1,2]. Alternative non–surgical treatment, and various pharmacological agents such as nitrates (glyceryl trinitrate, isosobide dinitrate), calcium channel blockers (nifedepine, diltiazem) have been shown to lower resting anal pressure and heal fissures without threatening anal continence [3]. The present study evaluates the effectiveness and side effects of internal sphincterotomy in the treatment of chronic fissure–in–ano.

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Article: Download PDF   DOI : 10.36106/ijsr  

Cite This Article:

Dr Jagdish B Karia, Dr Rutik Gandhi, Dr Ketul Shah, Study of Lateral Sphincterotomy in the Treatment of Chronic Fissure in Ano, INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH : Volume-7 | Issue-1 | January-2018

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