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OUTCOME OF TREATMENT OF ANAL FISSURE BY CLOSED LATERAL INTERNAL SPHINCTEROTOMY OPERATED WITH VON GREAVES (CATARACT KNIFE)

Talal Almas, Eyad Mansour, Muhammad Ali Niaz

Objective: To investigate whether the lateral internal anal sphincterotomy is minimally invasive in terms of symptomatic relief, continence and complications with the Von Greaves knife (cataract). Study design: A case-control study. Place and Duration: In the Surgical Unit II of Nishter Hospital, Multan for the duration of one year from June 2017 to June 2018 after the approval of the ethical committee. Methodology: Patients with chronic anal fissures were included in the study after informed consent was obtained. Patients with other simultaneous ano-rectal pathologies, such as polyps other than hemorrhoids or growths, were excluded. All patients underwent a modified lateral internal anal sphincterotomy with a minimally invasive Von-Greaves knife (cataract). Results: 250—220 men (75.3%) and 74 women (24.7%) who were between 18 and 70 years (mean age 39.2 years) of age partook in this study. Von-Greaves knife (cataract) was employed to perform internal sphincterotomy in all patients. Postoperative patients had demonstrably lower pain levels and were discharged the same day. Small complications were observed in 38 patients (12.6%). Hematoma was observed in 6 (2%) patients, impaired temporary control of flatus control was observed in 08 (2.6%) of the patients, fabric dirt was noted in 06 (2%), and 12 (4%) of the patients presented with urinary retention. Major complications such as bleeding in any patient, continuous incontinence of flatus and feces or recurrence were not reported. Conclusion: The division of the inner sphincter with a minimally invasive Von-Greaves knife (V.G) yield lower pain-levels and minimizes postoperative complications. Keywords: anal fissure, CLIS (closed lateral Internal anal sphincterotomy), von-greaves knife.

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