Nighat Ghayas, Muhammad Ghayassuddin, Syed Muneeb Younus, Abdul Jabbar Mirani, Sunil Suchdev, Altaf Hussain Jatoi, Saqib Bakshi.
Comparison of frequency of post-operative fecal incontinence in patients with closed versus open internal anal sphincterotomy: Experience at a tertiary care hospital in Pakistan.
Pak J Surg Jan ;30(2):150-5.

Objective: To compare the frequency of postoperative fecal incontinence in patients with closed lateral internal anal sphincterotomy with von greaves knife versus standard Park’s operation (open method) for chronic anal fi ssure. Design: Randomized Control Trial. Sett ing and Duration: Th e trial was conducted at department of Surgery, Kulsoom Bi Valika Social Security (KVSS) S.I.T.E. Hospital, Karachi, for a period of six months from 13th February 2011 to 12th August 2011. Methodology: Ninety four patients having chronic anal fi ssure were randomly assigned to groups A & B, with 47 patients in each group. Closed lateral internal anal sphincterotomy (CLIAS) via von greaves knife was carried out in patients of group A whereas patients of group B were subjected to open internal anal sphincterotomy (OIAS) also known as Parks’ procedure. Fecal incontinence was noted on the 5th post operative day. Results were recorded on a self-designed questionnaire. Data was analyzed using SPSS 16. P value of less than 0.05 was taken as signifi cant. Results: Th ere were 81(86.2%) males and 13(13.8%) females with male to female ratio being 6:1. Mean±SD of age was 38.38+14.56 years. Post-operative fecal incontinence in patients undergoing CLIAS was 4.3% while it was 21.3% in those undergoing OIAS with a p-value of 0.027. Conclusion: Closed lateral internal anal sphincterotomy (CLIAS) with Von Greaves knife is eff ective in reducing fecal incontinence on 5th postoperative day as compared to standard open internal anal sphincterotomy (OIAS).

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