Sagheer Ahmed, Tariq Iqbal, Muhammad Shuaib Abdullah.
Closed Internal Sphincterotomy in Chronic Anal Fissure: an experience at Bahawal Victoria Hospital, Bahawalpur.
Pak J Med Health Sci Jan ;8(1):31-3.

Aim: To evaluate the outcome of Closed Internal Sphincterotomy in chronic anal fissure in terms of haematoma, bleeding, pain, healing rate and incontinence. Study design: Cross sectional study Place & duration of study: It was a conducted at Surgery Department, Bahawal Victoria Hospital Bahawalpur from January 2011 to August 2013. Methods: Patients with chronic anal fissure were included in the study. Patients with previous Sphincterotomy, anal dilation and suspicion of malignant fissure, atypical fissure or ulcer were excluded from the study. Patients were operated under Spinal anaesthesia. All patients underwent Closed Internal Sphincterotomy. Post operative and out-patient follow-up was carried out for next 24 weeks to observe bleeding, haematoma, pain, healing rate and incontinence. Data was collected on predesigned questionnaire and analysed with SPSS – IBM version 20. Results: A total of 100 closed internal sphincterotomies were performed. Ninety patients (90%) were successfully followed-up at 2nd, 6th, and 24th week. Pain was significantly reduced in all patients during first a few postoperative hours, while bleeding and irritation were reduced in most patients (94%) by the morning of 2nd postoperative day. Complications of surgery comprised small haematoma in 2(2%) patients by 2nd postoperative day, pain lasted for 5 days in 1(1%) patient only and bleeding was also observed in 1(1%) patient. Conclusion: Closed lateral internal sphincterotomy for treatment of chronic anal fissures remains the method of choice, as it is a safe and effective procedure that leads to quick symptomatic improvement.

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