Internal Lateral Sphincterotomy in Yaounde: Comparative Short-Term Results of Open versus Closed Techniques

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.

CLINICAL OBSERVATION ON TREATMENT OF ANAL FISSURE BY APPLYING SPHINCTEROTOMY WITH ACUPOTOM

Objective: To observe the therapeutic effect and features of acupotomy in the treatment of anal fissure. Methods: Seventy-six cases with anal fissure were randomly divided into two groups, namely, acupotomy group in which 37 patients were treated by anal internal sphincterotomy with acupotomy, and conventional anal sphincterotomy group (conventional group, n=39) that was treated by conventional amputation of the anal sphincter. Results: After treatment, twenty-six over 37 cases in acupotomy group recovered completely and the other 9 cases were improved clinically, with the total effective rate being 94.59%. In conventional group, 27 over 39 cases recovered completely and the other 11 cases were improved clinically. The total effective rate was 97.44%. There was no significant difference in the curative rate between two groups. However, compared with those of conventional group, patients in acupotomy group had significantly less bleeding, earlier healing of fissure and less pain. Conclusion: The results suggest that acupotomy treatment of anal fissure with anal sphincterotomy is a better therapeutic technique with advantages of easier manipulation, earlier healing and milder wound, less infectious complications and pain.

Surgical treatment of anal stenosis

Anal stenosis is a rare but serious complication of anorectal surgery, most commonly seen after hemorrhoidectomy. Anal stenosis represents a technical challenge in terms of surgical management. A Medline search of studies relevant to the management of anal stenosis was undertaken. The etiology, pathophysiology and classification of anal stenosis were reviewed. An overview of surgical and non-surgical therapeutic options was developed. Ninety percent of anal stenosis is caused by overzealous hemorrhoidectomy. Treatment, both medical and surgical, should be modulated based on stenosis severity. Mild stenosis can be managed conservatively with stool softeners or fiber supplements. Sphincterotomy may be quite adequate for a patient with a mild degree of narrowing. For more severe stenosis, a formal anoplasty should be performed to treat the loss of anal canal tissue. Anal stenosis may be anatomic or functional. Anal stricture is most often a preventable complication. Many techniques have been used for the treatment of anal stenosis with variable healing rates. It is extremely difficult to interpret the results of the various anoplastic procedures described in the literature as prospective trials have not been performed. However, almost any approach will at least improve patient symptoms.