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Evaluation of Healing and Complications After Lateral Internal Sphincterotomy for Chronic Anal Fissure: Marginal Suture of Incision vs. Open Left Incision: Prospective, Randomized, Controlled Study

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Diseases of the Colon & Rectum

Abstract

Purpose

Internal sphincterotomy remains the standard for treatment of anal fissure, but it is associated with risks of infection, bleeding, and incontinence. Recent studies have suggested that the complications after lateral internal sphincterotomy are related to surgical technique. This study was designed to assess the incidence of early and late complications after lateral internal sphincterotomy with marginal sutured incision. Fissure healing, pain, and complications were compared in patients undergoing a procedure involving three interrupted marginal sutures after open lateral internal sphincterotomy procedure.

Methods

Ninety patients of chronic anal fissure were randomly assigned to two groups. Both groups received open lateral internal sphincterotomy via standardized method. The incisions of the patients in Group 1 (n = 45) were sutured marginally with three interrupted sutures using 2-0 chromic catgut, whereas the incisions of the patients in Group 2 (n = 45) were left open. The patients were assessed at 12 weeks postoperatively by an independent observer.

Results

The fissure-healing rate was not significantly different in both groups (95 and 93.1 percent, respectively). The pain score was slightly higher in Group 2, and it was statistically significant. Four cases of bleeding and two abscesses were observed in Group 2. These complications were not observed in Group 1. One case of incontinence was observed at the beginning in Group 1 and four in Group 2, but the incontinence was transient in both cases.

Conclusions

Marginal sutures of incision after lateral internal sphincterotomy may be beneficial to reduce complications related to early wound healing.

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References

  1. Schouten WR, Briel JW, Auwerda JJ, Boerman MO. Anal fissure: new concepts in pathogenesis and treatment. Scand J Gastroenterol 1996;218:78–81.

    Article  CAS  Google Scholar 

  2. Prohm P, Bonner C. Is manometry essential for surgery of chronic fissure-in-ano? Dis Colon Rectum 1995;38:735–8.

    Article  PubMed  CAS  Google Scholar 

  3. Xynos E, Trotzinis A, Chrysos E, et al. Anal manometry in patients with fissure-in-ano before and after internal sphincterotomy. Int J Colorectal Dis 1993;8:125–8.

    Article  PubMed  CAS  Google Scholar 

  4. Metcalf A. Anorectal disorders. Five common causes of pain, itching and bleedings. Postgrad Med 1995;98:81–4.

    PubMed  CAS  Google Scholar 

  5. Gorfine SR. Topical nitroglycerin therapy for anal fissure and ulcers. N Engl J Med 1995;333:1156–7.

    Article  PubMed  CAS  Google Scholar 

  6. Lund JN, Scholefield JH. A randomized prospective double blind placebo controlled trial of glyceryltrinitrate ointment in the treatment of anal fissure. Lancet 1997;349:11–4.

    Article  PubMed  CAS  Google Scholar 

  7. Jost WH. One hundred cases of anal fissure treated botulinum toxin: early and long-term results. Dis Colon Rectum 1997;40:1029–32.

    Article  PubMed  CAS  Google Scholar 

  8. Jost WH, Schmirik K. Therapy of anal fissure using botulinum toxin. Dis Colon Rectum 1994;37:1340.

    Article  PubMed  CAS  Google Scholar 

  9. Sohn N, Eisenberg MM, Weinstein MA, et al. Precise anorectal sphincter dilatation: its role in the therapy of anal fissures. Dis Colon Rectum 1992;35:322–7.

    Article  PubMed  CAS  Google Scholar 

  10. Hoffmann DC, Goligher JC. Lateral subcutaneous internal sphincterotomy in treatment of anal fissure. BMJ 1970;3:673–5.

    Article  PubMed  CAS  Google Scholar 

  11. Ray JE, Penfold JC, Gathright JB, Roberson SH. Presidential address: lateral Subcutaneous internal anal sphincterotomy for anal fissure. Dis Colon Rectum 1974:17:139–44.

    Article  PubMed  CAS  Google Scholar 

  12. Jonas M, Scholefield JH. Anal fissure. Gastroenterol Clin North Am 2001;30:167–81.

    Article  PubMed  CAS  Google Scholar 

  13. Notaras MJ. Lateral sphincterotomy for anal fissure: a new technique. Proc R Soc Med 1969;62:713.

    PubMed  CAS  Google Scholar 

  14. Argov S, Levandovsky O. Open lateral sphincterotomy is still the best treatment for chronic anal fissure. Am J Surg 2000;179:201–2.

    Article  PubMed  CAS  Google Scholar 

  15. Isbister WH, Prasad J. Fissure-in-ano. ANZ J Surg 1995;65:107–8.

    Article  CAS  Google Scholar 

  16. Garcia-Aguilar J, Belmonte C, Wong WD, Lowry AC, Madoff RD. Open vs. closed sphincterotomy for chronic anal fissure: long-term results. Dis Colon Rectum 1996;39:440–3.

    Article  PubMed  CAS  Google Scholar 

  17. Nelson R. Operative procedures for fissure in ano. Cochrance Review. In: The Cochrance Library Issue 4. Chichester: Wiley, 2003.

  18. Aysan E, Aren A, Ayar E. A prospective, randomized, controlled trial of primary wound closure after lateral internal sphincterotomy. Am J Surg 2004;291–4.

  19. Arroyo A, Perez F, Serrano P, Candela F, Calpena R. Open versus closed lateral sphincterotomy performed as an outpatient procedure under local anesthesia for chronic anal fissure: prospective randomized study of clinical and manometric long-term results. J Am Coll Surg 2004;199:361–7.

    Article  PubMed  Google Scholar 

  20. Oueidat D. A comparative study in anal fissure treatment. J Med Liban 1999;47:164–8.

    PubMed  CAS  Google Scholar 

  21. Abcarian H. Surgical correction of chronic anal fissure: results of lateral internal sphincterotomy vs. fissurectomy: midline sphincterotomy. Dis Colon Rectum 1980;23:31–6.

    Article  PubMed  CAS  Google Scholar 

  22. Tocchi A, Mazzoni G, Miccini M, Cassini D, Bettelli E, Brozzetti S. Total lateral sphincterotomy for anal fissure. Int J Colorectal Dis 2004;19:245–9.

    Article  PubMed  Google Scholar 

  23. Hananel N, Gorgon PH. Lateral internal sphincterotomy for fissure-in-ano-revisited. Dis Colon Rectum 1997;40:597–602.

    Article  PubMed  CAS  Google Scholar 

  24. Kortbeek JB, Langevin JM, Khoo RE, Heine JA. Chronic fissure-in-ano: a randomized study comparing open and subcutaneous lateral spnincterotomy. Dis Colon Rectum 1992;35:835–7.

    Article  PubMed  CAS  Google Scholar 

  25. Oh C, Divino CM, Steinhogen RM. Anal fissure: 20-year experience. Dis Colon Rectum 1995;38:378–82.

    Article  PubMed  CAS  Google Scholar 

  26. Pernikopf BJ, Eisenstat TE, Rubin RJ, Oliver GC, Salvati EP. Reappraisal of partial lateral internal sphincterotomy. Dis Colon Rectum 1994;37:1291–5.

    Article  Google Scholar 

  27. Syed SA, Waris S, Ahmed E, Saeed N, Ali B. Lateral internal anal sphincterotomy for anal fissure: with or without associated anorectal procedures. J Coll Physicians Surg Pak 2003;13:436–9.

    PubMed  Google Scholar 

  28. Oueidat D. A comparative study in anal fissure treatment. J Med Liban 1999;47:164–8.

    PubMed  CAS  Google Scholar 

  29. Leong AF, Husain MJ, Seow-Choen F, Goh-HS. Performing internal sphincterotomy with other anorectal procedures. Dis Colon Rectum 1994;37:1130–2.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Daehan Wellness Hospital, Yeonjaegu Yeonsandong, 589-9, Pusan, South Korea

    Gyong-Suk Kang M.D., Ph.D., Byoung-Soo Kim M.D., Phil-Sun Choi M.D. & Dong-Wan Kang M.D., Ph.D.

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  1. Gyong-Suk Kang M.D., Ph.D.
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  2. Byoung-Soo Kim M.D.
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  3. Phil-Sun Choi M.D.
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  4. Dong-Wan Kang M.D., Ph.D.
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Correspondence to Gyong-Suk Kang M.D., Ph.D..

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Kang, GS., Kim, BS., Choi, PS. et al. Evaluation of Healing and Complications After Lateral Internal Sphincterotomy for Chronic Anal Fissure: Marginal Suture of Incision vs. Open Left Incision: Prospective, Randomized, Controlled Study. Dis Colon Rectum 51, 329–333 (2008). https://doi.org/10.1007/s10350-007-9122-2

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  • DOI: https://doi.org/10.1007/s10350-007-9122-2

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