TITLE:
Internal Lateral Sphincterotomy in Yaounde: Comparative Short-Term Results of Open versus Closed Techniques
AUTHORS:
Georges Bwelle Motto, Yannick Mahamat Ekani Boukar, Guy Aristide Bang, Joseph Cyrille Chopkeng Ngoumfe, Fabrice Tientcheu Tim, Arthur Essomba, Maurice Aurélien Sosso
KEYWORDS:
Anal Fissure, Internal Lateral Sphincterotomy, Open Technique, Close Technique
JOURNAL NAME:
Surgical Science,
Vol.12 No.11,
November
29,
2021
ABSTRACT: Background: Chronic anal fissure is a benign disorder which is
associated with considerable discomfort. Aim
of the Work: The aim of this study was to compare the
post-operative results of open and closed internal lateral sphincterotomies in
the short and medium term. Patient
and Methods: We carried out a prospective randomized comparative
study in the digestive and visceral surgery departments of Central Hospital of
Yaounde over a period of 15 months. Patients were evaluated for each technique
by several variables, including duration of surgery, post-operative pain,
recurrence, surgical wound infection, gas and/or stool incontinence, and healing
time with follow-up up to 12 months postoperatively. Results: A total of 63 patients underwent surgery within them
we had 32 open lateral internal sphincterotomies (group 1) and 31 closed lateral internal sphincterotomies (group 2). There were 35 men and 28 women with a
sex ratio of 1.25. The mean age was 35.36 ± 10.16 years with extremes ranging
from 19 to 62 years. The typical presentation was pain on defecation. The
majority of fissures were located at the posterior commissure. The average
duration of the procedure was longer in patients in group 1 (15.34 minutes)
compared to 5.22 minutes in patients in group 2. We found 3.12% of surgical
wound infections in patients in group 1 and neither patient in group 2. Gas
incontinence was 6.45% in group 2 patients and 28.12% in group 1. The mean intensity of pain at 24 hours
post-operative was between 4 and 6 on the visual analogue scale in
patients in group 2 and between 7 and 10 in group 1. Wound healing time was 8.9
days in group 1 and 4 days in group 2 patients. The hospital stay
was 24 hours for both groups of patients. No recurrence was noted during the
6-month follow-up period. Conclusion: Closed lateral internal anal
sphincterotomy is the treatment of choice for chronic anal fissures because it
is effective and associated with a lower complication rate than
the open sphincterotomy technique.