A PROSPECTIVE COHORT STUDY COMPARING TAILORED AND CONVENTIONAL LATERAL INTERNAL SPHINCTEROTOMY FOR CHRONIC ANAL FISSURES
DOI:
https://doi.org/10.69723/njms.04.03.0616Keywords:
Anal fissures, Conventional lateral internal Sphincterotomy, Tailored lateral internal Sphincterotomy, LIS, faecal incontinence, flatus incontinenceAbstract
BACKGROUND: Anal fissure is defined as a superficial tear in the skin distal to the dentate line and is one of the leading causes of hospitalization among proctologic disorders. Anal fissures are initially managed by conservative treatments, but have limited efficacy and may need surgical interventions.
OBJECTIVE: The current study aimed to compare the effectiveness of Conventional lateral internal Sphincterotomy (LIS) versus tailored LIS in terms of pain, bleeding and recurrent symptoms as outcomes.
METHODOLOGY: The prospective cohort study was carried out at Muhammad Teaching Hospital, Peshawar, including n=196 participants, diagnosed with Chronic anal fissures, over the age of 18 years, through informed consent. Patients were assessed for pain, bleeding, and recurrent symptoms pre-operatively and post-operatively at one-month intervals of follow-up.
RESULTS: The Mean age of the participants was 34.50±11.18 years, including 52 (26.5%) males and 144 (73.5%), operated with Conventional LIS 94 (48%), and tailored LIS 102 (52%). Post-operative pain was significantly reduced, P<0.001 in both groups, with no difference P=0.182, between interventions. For flatus incontinence Significant difference by Fisher’s exact test P=0.028 reported between interventions, with a relative risk RR= 0.204 (CI 0.045-0.923), 0.039 for tailored LIS. For faecal incontinence, Fisher's exact test P=0.011 was significant between groups, and RR=0.070 (CI 0.004-1.242), P=0.070 was insignificant. Faecal soiling P=0.108, recurrent symptoms P=0.152, post-operative constipation P=0.124, and pruritus P=0.030 did not report significant differences among treatment groups when conventional LIS was compared with tailored LIS.
CONCLUSION: Conventional LIS and tailored LIS were both effective in post-operative pain and bleeding reduction. Tailored LIS helped reduce post-operative flatus and faecal incontinence. The study was limited by a short follow-up duration and insufficient consideration of patients’ medical histories and comorbidities.
KEYWORDS: Anal fissures, Conventional lateral internal Sphincterotomy, Tailored lateral internal Sphincterotomy, LIS, faecal incontinence, flatus incontinence.
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