title: Lateral Anal Sphincterotomy for Chronic Anal Fissures- A Comparison of Outcomes and Complications under Local Anaesthesia Versus Spinal Anaesthesia.
abstract: BACKGROUND
  Fissure-in-Ano is one of the common and most painful anorectal conditions encountered in surgical practice. Inspite of several conservative treatment options, surgical treatment in the form of Lateral Anal Spincterotomy (LAS) remains the gold standard of treatment for Chronic Anal Fissures (CAF). However, LAS is often done under spinal or general anaesthesia incurring huge treatment costs and hospital stay.
  
  
  OBJECTIVE
  To study if LAS can be treated with Local Anaesthesia (LA) thereby, reducing the costs and the anaesthetic risk to patients with no significant change in the surgical ease or clinical outcome.
  
  
  METHODS
  A total of 79 patients with chronic fissure underwent randomized allocation to two treatment arms - The first to undergo LAS under LA and the second under Spinal Anaesthesia (SA). The primary outcome variables studied were complications like post-operative pain, infections, healing rate of fissure and incontinence rates. Secondary outcome variables studied were cost, hospital stay and need for additional anaesthetic.
  
  
  RESULTS
  A total of 79 patients underwent LAS procedure. A total of 42 patients had LA and 39 patients had SA. There was no statistically significant difference in the healing rate, pain, infection and incontinence rates between the two groups. Moreover, the LA group incurred lower cost, reduced hospital stay and reduced risk of anaesthesia.
  
  
  CONCLUSIONS
  LAS can be satisfactorily performed under local anaesthesia with no increased risk of pain or complications, and is best suited for resource-poor surgical settings.
authors.affiliation: Consultant Surgeon, Department of General Surgery, Tribal Health Initiative , Dharmapuri, Tamil Nadu, India .
authors.forename: Ravikumar
authors.initials: R
authors.lastname: Manoharan
authors.affiliation: Assistant Professor, Department of Paediatric Surgery, Christian Medical College , ISSCC Building, Vellore, Tamil Nadu, India .
authors.forename: Tarun
authors.initials: T
authors.lastname: Jacob
authors.affiliation: Professor, Department of General Surgery, NH Narayana Multispecialty Clinic , Bengaluru, Karnataka, India .
authors.forename: Santosh
authors.initials: S
authors.lastname: Benjamin
authors.affiliation: Consultant Surgeon, Department of General Surgery, Christian Fellowship Hospital , Oddanchatram, Tamil Nadu, India .
authors.forename: Sumonth
authors.initials: S
authors.lastname: Kirishnan
keywords: Anorectal condition; Fissure-in-Ano; Sphincter spasm