Objective & Background:  Basis of treatment of chronic anal fissure lies in decreasing spasm of internal anal sphincter. Open lateral internal sphincterotomy (OLIS) and Closed lateral internal sphincterotomy (CLIS) are two different methods for relaxing fibres of internal anal sphincter which result in healing of ulcer. These 2 methods have been compared in some previous research in terms of post operative complications i.e. pain, discharge, hospital stay, incontinence & recurrence. This study was done to determine better method in terms of above complications.

Method: 100 patients with chronic anal fissure were randomly selected irrespective of age and gender and randomly allocated into group A and B.50 patients of group A underwent CLIS while 50 patients of group B underwent OLIS. Patients were followed up for 12 months after procedure. Results were compared in terms of pain, bleeding, infection, incontinence of flatus& faeces and recurrence.

Result: Postoperative pain was reported more in OLIS group (12%) as compared to CLIS group (8%) (p<0.001 which is significant).Bleeding during defaecation in follow-up period was almost equal in OLIS group (6%) as compared to 4% in CLIS group. Temporary incontinence of flatus and faeces was 12% in OLIS vs 6% in CLIS (p<0.05).Recurrence was 14% in OLIS vs 16% in CLIS. Postoperative stay was average 2.5 days in CLIS group as compared to average 6 days in OLIS.

Conclusion: CLIS is a safe procedure in terms of lesser hospital stay, lesser post operative pain and least incontinence as compared to OLIS. It has an accepted rate of complications and should be adopted by experienced surgeons in the treatment of chronic anal fissure.

Keywords: OLIS; CLIS; sphincterotomy; fissure.

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Dr Akash Kumar Singh

NMCH Patna