Evaluation of healing and complications after lateral internal sphincterotomy for chronic anal fissure: marginal suture of incision vs. open left incision: prospective, randomized, controlled study.
OBJECTIVE
Internal sphincterotomy remains the standard for treatment of anal fissure, but it is associated with risks of infection, bleeding, and incontinence. Recent studies have suggested that the complications after lateral internal sphincterotomy are related to surgical technique. This study was designed to assess the incidence of early and late complications after lateral internal sphincterotomy with marginal sutured incision. Fissure healing, pain, and complications were compared in patients undergoing a procedure involving three interrupted marginal sutures after open lateral internal sphincterotomy procedure.


METHODS
Ninety patients of chronic anal fissure were randomly assigned to two groups. Both groups received open lateral internal sphincterotomy via standardized method. The incisions of the patients in Group 1 (n=45) were sutured marginally with three interrupted sutures using 2-0 chromic catgut, whereas the incisions of the patients in Group 2 (n=45) were left open. The patients were assessed at 12 weeks postoperatively by an independent observer.


RESULTS
The fissure-healing rate was not significantly different in both groups (95 and 93.1 percent, respectively). The pain score was slightly higher in Group 2, and it was statistically significant. Four cases of bleeding and two abscesses were observed in Group 2. These complications were not observed in Group 1. One case of incontinence was observed at the beginning in Group 1 and four in Group 2, but the incontinence was transient in both cases.


CONCLUSIONS
Marginal sutures of incision after lateral internal sphincterotomy may be beneficial to reduce complications related to early wound healing.
Kang
Gyong-Suk
GS
Daehan Wellness Hospital, Yeonjaegu Yeonsandong, 589-9, Pusan, South Korea. sukk123@yahoo.com
Kim
Byoung-Soo
BS
Choi
Phil-Sun
PS
Kang
Dong-Wan
DW
D000328:Adult; D000704:Analysis of Variance; D002908:Chronic Disease; D005260:Female; D005401:Fissure in Ano / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008297:Male; D010147:Pain Measurement; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D013536:Suture Techniques; D016896:Treatment Outcome; D014945:Wound Healing