Unilateral versus bilateral lateral internal sphincterotomy: a randomized controlled trial for chronic fissure in ano.
BACKGROUND
Standard treatment for Chronic Anal Fissure (CAF) is unilateral Internal Sphincterotomy (UIS). Still there is recurrence and the risk of of incontinence. Bilateral Internal Sphincterotomy (BIS) as a treatment for CAF has not been adequately evaluated.


METHODS
A prospective randomized controlled trial of UIS at 3 o'clock compared with BIS at 3 and 9 'O' clocks. The outcome variables were: post operative pain, recurrence and incontinence.


RESULTS
There was 104 and 107 cases in UIS and BIS group respectively with similar age and sex. There were 12 recurrences in UIS and only one in the BIS group (p < 0.001) with no change in the continence. BIS group had less pain (p < 0.001).


CONCLUSIONS
BIS for CAF resulted in less postoperative pain, lower recurrence with no increase in the incontinence. However, further study is required with pre and post operative anal manometry.
Pujahari
Aswini K
AK
Department of Surgery, Armed Forces Medical College, Pune & Command Hospital (AF), Bangalore. akpuja@rediffmail.com
D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000601:surgery*; D002908:Chronic Disease; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D005401:Fissure in Ano / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D016896:Treatment Outcome