Guljar Ahmed1, Md. Siddiqur Rahman2, Mamun Ibn Munim3, Md. Jasim uddin4
1. Associate Professor (CC), Surgery, North East Medical College, Sylhet
2. Associate Professor (CC), Urology, North East Medical College, Sylhet
3. Assistant Professor (CC),Surgery, North East Medical College, Sylhet
4. Assistant Professor (CC), Surgery, North East Medical College, Sylhet
Abstract
Two main surgical options exist for the current treatment of chronic anal fissure: manual dilatation of the anus (MDA) and lateral internal sphincterotomy (LIS). The high incidence of incontinence after MDA is widely documented. This study was set for observation of theoutcome of MDA in clinical management of chronic anal fissure. 58 patients underwent surgical treatment for chronic anal fissure. The options they were given included manual anal dilatation (MDA) and lateral internal anal sphincterotomy (LIS). These patients have been followed- up from January 2014 to December 2014 and their outcome and compliance observed. MDA done for 31 (53.4%) and LIS done for 27 (46.6%) patients. 26 (44.8%) cases were male and 32 (55.2%) were female. Most of the patients, 38 (65.5%) were stayed in hospital for 2 days, subsequently 16 (27.6%) for 1 day and only 4 (6.9%) for 3 days. Among post-operative complications, the highest is incontinence to flatus, 58.6% (34); of which 39.7% (23) for MDA and 19% (11) for LIS procedure. These data show a high incidence of MDA as the treatment of choice for chronic anal fissure with almost equal outcome in comparison to LIS. The implications of such a practice are discussed.
Keywords: Anal fissure, Manual dilatation of anus, Lateral internal sphincterotomy, Glyceryl trinitrate, Operative complications, Faecal incontinence.