Zana Nasraddin Mohialdeen.
Background: The search for an alternative to lateral internal sphincterotomy,the standard surgery for chronic anal fissure which may be complicated by anal fecal incontinence, is continuing. Fissurectomy is one of the alternatives, but this also done under general or spinal anesthesia. Few studies had explored the possibility of doing fissurectomy under local anesthesia anal infiltration and this study tries to explore this approach.
Aims: To evaluate the role of minimally - invasive surgical fissurectomy in patients with chronic anal verge fissure failed to cure by optimal medical therapy.
Patients and Methods: We evaluated a minimally - invasive surgical fissurectomy for inducing healing of these fissures. The procedure was done under local anesthesia (xylocaine + adrenaline 20 ccs) infiltration around the anus and conscious sedation of pethidine 100 mgm and Medazolam 5 mgm both given intravenous 5 minutes before the local xylocaine infiltration. We evaluated the patients for absence of pain during defecation and the complete
healing of the wound area, 3 weeks and 3 months after the operation., to know the short-term and long-term cure rates.
Results: Among 35 patients with chronic anal fissures failed to heal by medical therapies, fissurectomy under local anesthesia infiltration around the anus facilitated by giving a proper dose of intravenous conscious sedation, had resulted in an excellent outcome with a healing rate of 95% & fewer and less severe anal incontinence rate of 8%.
Conclusion: Anal fissure occurs in young persons more in females and commonly in posterior location of anal verge. Minimally invasive fissurectomy under local anesthesia with the help of conscious sedation can be a good alternative to classical lateral internal sphincterotomy which has higher anal incontinent rates, sometimes perminant.View pdf