Comparative study of lateral anal sphincterotomy for chronic Fissure-In-Ano under local Vs spinal anaesthesia
Authors: SAJID IBRAHIM ALI  , ADIL MOHAMED  , SACHIN MURUKANAHALLI BASAVARAJU  , B P SUNIL  
Published: May 2023

Background: Fissure-in-Ano is one of the common and most painful anorectal conditions encountered in surgical practice. An acute fissure is a simple tear in anoderm, whereas a chronic anal fissure is an ulceration with built-up scarred edges and exposed internal anal sphincter muscle fibres at its base, most of the time associated with sentinel pile. Surgical therapy traditionally has been recommended for Fissure in Ano that have failed medical therapy. surgical treatment in the form of Lateral Anal Sphincterotomy (LAS) remains the gold standard of treatment for Chronic Anal Fissures (CAF). LAS can be done under spinal anaesthesia or local anaesthesia. Objectives: To compare post-operative outcomes of LAS done under local anaesthesia to spinal anaesthesia and to compare duration of stay in hospital of local anaesthesia to spinal anaesthesia. Methods: Prospective comparative study conducted on 80 patients attending the outpatient department of Karnataka institute of medical sciences Hubli for treatment of chronic fissure in ano. Patients were divided into two groups, Group A under Local anaesthesia (LA) and Group B under Spinal anaesthesia (SA). After history, clinical examination and routine investigations patients were subjected to Lateral anal Sphincterotomy (LAS). The outcome variables studied were postoperative pain, early postoperative complications and hospital stay. Results: In the study group 50 were males and 30 were females and majority were in 2nd and 3rd decade. There was no difference between both groups regarding sex wise distribution and age wise distribution. Most common presenting symptoms were pain during defecation (100%), bleeding per rectum (68.75%), constipation (46.25%) and pruritis ano (16.25%). Fissures noted 80% posteriorly, 15% anteriorly and both in 5%. Both groups underwent LAS and post-operative complications, duration of surgery, postoperative duration of hospital stay were documented. post-operative pain was significantly less in LA group (group A) at 4th hour, postop day 1 after surgery comparing to spinal anaesthesia group (group B). 17.5% patients in group A had postoperative bleeding and 25% patients in group B had postoperative bleeding. 32.50% patient had nausea & vomiting, 20% patient had retention of urine and 12.5% patients had head ache in group B which were not seen in group A patients. Duration of surgery was less in group A (23.75 ± 4.04 minutes) comparing group B (32.38 ± 7.07 minutes). Postoperative duration of stay was less in group A (0.83 ± 0.45) comparing to group B (1.45 ± 0.55). there was no difference in healing of wound between two groups with 92.5% of the patients had healing at 4 weeks and 7.5% at 6 weeks. Conclusion: After these observations and findings, it is apparent that lateral anal sphincterotomy (LAS) done under local anaesthesia has significantly less postoperative pain, has lesser incidence of postoperative complications and lesser duration of hospital stay when compared to LAS done under spinal anaesthesia. Hence LAS can be satisfactorily performed under local anaesthesia with added benefits and less complications and is best suited for resource-poor surgical settings.