EXTENT OF LATERAL INTERNAL SPHINCTEROTOMY FOR CHRONIC ANAL FISSURE: SPASM CONTROLLED VERSUS CONVENTIONAL METHOD: A PROSPECTIVE RANDOMIZED STUDY

Aim: This study was designed to compare the results of spasm controlled lateral sphincterotomy by using anal calibrator with those of conventional sphincterotomy Method: This study included 96 patients with chronic anal fissure divided into two groups. In conventional sphincterotomy group, the extent of sphincterotomy was up to dentate line and in spasm controlled group the extent of sphincterotomy at first to the apex of fissure then serial small sphincterotomies and anal caliber measurements followed up until an anal caliber of 30 mm was obtained Results: The preoperative anal caliber was 26+2.9 (19-26) and 26+2.7 (18-28) mm in conventional group and spasm controlled group respectively. Postoperatively the spasm controlled group had a mean anal caliber 32.8+2.4 and in conventional group had 34.7+2.4. Delayed healing was occurred in 12.5% of patients in conventional group vs. 4.2% in spasm controlled group p =0.06. Incontinence to flatus occurred in 4.2 % of patients in spasm controlled and 16.7 % in conventional group p =0.05. relief of pain postoperatively was after 2.1+2.6 days in conventional group and in controlled sphincterotomy group after 3.7+3.5 days p=0.09. Conclusion: spasm controlled sphincterotomy provided better healing with lower rate of early and late postoperative disturbance of continence compared with conventional sphincterotomy