Closed internal sphincterotomy using von grafae knife vs open sphinterotomy in the management of chronic anal fissures in a tertiary care institute of Amravati.

DR BHARAT SHETE; DR YOGENDRA P CHIDRAWAR

Volume : VIII, Issue : IX, September - 2019

Closed internal sphincterotomy using von grafae knife vs open sphinterotomy in the management of chronic anal fissures in a tertiary care institute of Amravati.

Dr Bharat Shete, Dr Yogendra P Chidrawar

Abstract :

Background: Fissure in ano is one of the commonest benign and painful proctologic diseases causing considerable morbidity and reduction in quality of life. There are medical as well as surgical treatment options for anal fissure. The present study was conducted to find out the efficacy of closed internal sphincterotomy using von grafae knife for the management of chronic anal fissures. Methods: This was a study conducted at Department of surgery, Dr. PDMMC hospital, Amravati, Maharashtra, India from April 2018 to April 2019 for a period of 1 year. 80 patients with chronic anal fissure were randomly assigned into group A (40 patients) and group B (40 patients). Group A patients underwent open sphincterotomy, group B closed sphincterotomy using Von grafae knife. After matching the baseline characteristics; post op pain, wound infection, hematoma, fecal and flatus incontinence were compared. Results: 4 out of 40 patients had wound infection in group A, 1 out of 40 had infection in group B. 8 out of 40 (10%) developed flatus incontinence temporarily in group A, 3 out of 40 (7.5%) in group B. 3 out of 40 (7.5%) had fecal continence in group A, none had it in group B but incontinence was temporary. Pain (VAS>6) was more in group A than group B. One patient had hematoma as a complication in group A. Conclusions: Closed internal sphincterotomy using von grafae knife is a better technique compared to open technique in terms of pain, wound infection, incontinence.