Balamurugan, P (2016) Comparative Study of Lateral Internal Sphicterotomy and Lateral Internal Sphincterotomy with V-Y Advancement Flap in Treatment of Chronic Anal Fissure. Masters thesis, Coimbatore Medical College, Coimbatore.
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Abstract
INTRODUCTION : Anal fissure is a common problem that causes substantial morbidity in who are otherwise healthy. Anal fissure is an elongated ulcer in the long axis of lower anal canal .The most frequent site for anal fissure is midline posteriorly followed by midline anteriorly. The disease is more common in men while it is uncommon in children and elderly. It causes severe pain during defecation and rectal bleeding that stains the tissue or streaks the stools. The pathogenesis of chronic anal fissure remains incompletely understood but most are associated with a high resting anal pressure and reduced perfusion at the fissure site due to persistent hypertonia and spasm of the internal anal sphincter. AIMS OF THE STUDY ; 1. To compare the efficacy of lateral internal sphincterotomy against lateral internal sphincterotomy with V-Y advancement flap in treatment of chronic anal fissures. 2. To compare the complications associated with procedures. 3. To assess the added advantages of V-Y advancement flap in treatment of chronic anal fissure in terms of wound healing, time of relief of pain, persistent symptoms and patients satisfaction. 4. To decide on the better treatment of chronic anal fissure based on the findings from the study. MATERIALS AND METHODS : Design of the study : A prospective study Place where the study was conducted: Department of General Surgery, Government medical college hospital, Coimbatore. Study period : One year, commencing from August- 2014 ending by July- 2015 Study population: Patient with chronic anal fissure from all surgical unit (S1-S6) who were not responding to conservative management. Sample size : 50 Inclusion criteria: Patient in the age group of 15-80 years in both sex with chronic anal fissure not responding to conservative management. Exclusion criteria: Patient with either of following Pregnant patient Patient with acute fissure Patient with large sentinel tag Patient with age >80 years Patient with signs and symptoms of coagulopathy Patient not capable of giving consent Patient unwilling to undergo the study (who refused to give consent) Patient with history of fecal incontinence or anal stenosis. RESULTS : This study included 50 patients with chronic anal fissure. All the patients underwent a lateral internal sphincterotomy. A total of 30 patients were randomized to receive only lateral internal sphincterotomy (Group A) and the remaining patients were subjected to anal advancement flap. CONCLUSION : Lateral internal sphincterotomy is standard procedure for patients with chronic anal fissure. Addition of advancement flap with lateral sphincterotomy resulted in 1. Improvement of postoperative pain relief and patient comfort. 2. Postoperative urinary retention was same in both procedure. 3. Postoperative faecal soiling and faecal incontinence was almost equal in both the groups. 4. There was no increase in rate of recurrence during the six months follow up period. 5. Advancement flap increase the duration of surgery and hospital stay. 6. Earlier and quicker healing of fissure noted in advancement flap. 7. Duration of hospital stay was more in the advancement flap. Adding advancement flap with lateral sphincterotomy in patients with chronic anal fissure results in good postoperative pain relief and more patient comfort and early wound healing of the fissure.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Lateral Internal Sphicterotomy, Lateral Internal Sphincterotomy, V-Y Advancement Flap, Chronic Anal Fissure, Comparative Study. |
| Subjects: | MEDICAL > General Surgery |
| Depositing User: | Subramani R |
| Date Deposited: | 11 Jan 2018 02:41 |
| Last Modified: | 11 Jan 2018 02:41 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/5448 |
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