Comparison between Lateral Internal Sphincterotomy And Lord’s Operation for Chronic Anal Fissure

Abstract

Introduction: Anal fissure is an elongated ulcer in lower anal canal which presents with severe perianal pain during and after defecation with red streaks of blood. Chronic anal fissure is a fissure for more than six weeks with a skin tag (sentinel tag). Surgical options include Lord's dilatation of anus, lateral internal sphincterotomy (LIS) and posterior anal flap.

Aims & Objectives: To compare LIS and Lord's operation in cases of chronic anal fissure in terms of occurrence of incontinence.

Place and duration of study: Department of General Surgery, Ayub Teaching Hospital Abbottabad from September 2018 to March 2019.

Material & Methods: This quasi-experimental study was carried on 92 patients with anal fissure. By convenience (non- probability) sampling patients were divided into two equal groups of 46 patients as group A for LIS and group B for Lord's dilatation. Data was collected on a structured proforma and analyzed using SPSS 20.

Results: Flatus incontinence was observed in 1 (1.1%) fecal incontinence was in 11 (12.0%). Flatus incontinence occurred in 1 (1.1%) patient of group A while no flatus incontinence was reported in patients of group B. Fecal incontinence is observed in 10 (10.9%) patients with group A while 1(1.1%) of patients in group B had fecal incontinence. The result was significant with chi square value 9.614 and p value 0.008.

Conclusion: Lord's dilatation is a better procedure than Lateral internal sphincterotomy in terms of fecal incontinence.