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    • Extent of Lateral Internal Sphincterotomy in Female Patients with Chronic Anal-Fissure

    Hassan A.Saad, Kamal Rabi Eid, Tamer Mohamed Elshahidy
    General Surgical Department Zagazig University‚ Alazhar Domitti University

    Introduction: Lateral internal sphincterotomy is the ideal surgical management of chronic anal fissure. Excess division of the internal sphincter leads to incontinence either to stool or flatus or both especially in females because of anatomical causes or previous trauma. Also insufficient muscle cutting leads to recurrence so; we must determine the extent of lateral sphincterotomy for satisfactory results. Patients and methods: This study was done in the period from Aug 2017 to Dec 2018 in the General Surgery Department of Zagazig University. Sixty two female patients with chronic anal fissure with mean ages of (34.1 + 8.2) group A and (41.8 + 9.05) of group B were complaining of chronic anal fissure. Group A of (31) patients (50%) of study cases were subjected to lateral internal sphincterotomy up to the fissure apex. Group B of (31) patients (50%) of study cases were subjected to lateral internal sphincterotomy up to 50% of fissure length. Aim of our work: To compare the results of lateral internal sphincterotomy using two techniques : up to the apex of the chronic fissure or up to 50% of the fissure length to avoid incontinence either to stool or flatus in both females groups and ensure rapid fissure healing , rapid pain relief and low recurrence rate. Results: Group A showed complete fissure healing in 4 weeks (25) patients (80.6%) with (6 )patients cases comprising (19.35%) with delayed wound healing in 6 weeks .( 9 ) patients ( 29 % ) had transient incontinence to flatus . one(3%) patient only had recurrence after 6 months follow up Group B showed complete fissure healing in 5 weeks (20) patients (64.5%) with (11 )patients cases comprising (35.5%) with delayed wound healing in 6 weeks .( 2) patients ( 6 % ) had transient incontinence to flatus and 2patients(6%) had recurrence after 6 months follow up Conclusions: In females with chronic anal fissure, division of internal sphincter up to 50% of fissure length is usually sufficient and no need to reach apex of the fissure to preserve the internal sphincter function and prevent incontinence either to stool or to flatus. Key wards: Fissure-female-sphincter-lateral sphinterotomy.

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