LATERAL INTERNAL SPHINCTEROTOMY FOR TREATMENT OF CHRONIC ANAL FISSURE IN PEDIATRICS

Abstract

Background: Lateral internal sphincterotomy is a well established surgical technique for treatment of chronic anal fissure in the adult. The aim of this study was toevaluate the outcome of lateral internal sphincterotomy in Pediatrics. Subject and Methods: This is a prospective study performed over a period of 4 years from October 2008 to October 2012 on 37 patients with the chronic anal fissure of a duration exceeding three months and history of failure to conservative treatment. All patients underwent left lateral internal sphincterotomy through an open technique. The outcome was evaluated by assessing the effectiveness of this procedure in relieving the symptoms, fissure healing, parents’ satisfaction and complication rate. Results: There were 26 boys and 11 girls, mean age was 11 months with a range of (6 months – 12 years), and symptoms were relieved within two weeks in 28 cases and within one month in 5 cases. 4 patients require postoperative oral laxative for 1-3 months to overcome the withholding behavior. Fissures healed in 34 by eight weeks postoperatively. Parents were satisfied with the outcome in 32 patients. Four patients developed postoperative bleeding, and only one of them was serious and required cauterization, soiling occurred in 3 cases. No permanent incontinence was reported. Conclusions: Lateral internal sphincterotomy is an effective and safe surgical technique for treatment of chronic anal fissure not responding to medical therapy in pediatric. Complications are uncommon, and the risk of incontinence is very minimal if the proper surgical technique is performed. Duhok Med J 2018; 12 (1): 24-30.