Muhammad Jalil Malik, Amir Rashid, Riaz Anwar Bashir.
Comparative study of Internal Anal Sphincterotomy and Anal dilatation in acute Anal Fissure.
Pak Armed Forces Med J Jan ;54(2):142-6.

A cohort, comparative, non randomized study between lateral internal sphincterotomy (LIS) and manual dilatation of anus (MDA) was carried out for acute anal fissure at Combined Military Hospital (CMH) Lahore. The study included 46 patients divided into two groups. Group A underwent LIS and Group B MDA over a period of one and a half year. Patients who were diagnosed as a case of acute anal fissure on history, clinical examination and per rectal examination were included in the study. Most of the patients were army soldiers and their families admitted in CMH Lahore. Both procedures were carried out under general anesthesia. Chronic anal fissure patients were not included in the study. A proforma was devised to record patient`s particulars, history, and clinical examination, per rectal findings, operative methods, post operative recovery and complications. Sigmoidoscopy was performed per operatively to rule out any secondary cause of anal fissure. Follow up time was 6 months. Recurrence rate and prolapse of haemorrhoids was in 1 (2.17 percent) in group B while no recurrence in group A. Most of complications were minor and resolved spontaneously. Reoperations included one haemorrhoidectomy and one LIS who had recurrence after MDA. Pain relief was within first 24 hours in both groups. Average time to return to work was 7 days in group A while 11 days in group B. Our experience by this prospective comparative study strongly suggests that subcutaneous lateral internal sphincterotomy under general anesthesia is the most effective method of management for acute anal fissure regarding post operative complications, loss of work hours and pain relief.

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