Short-term and Long-term Complications Following Surgical Lateral Internal Sphincterotomy for Chronic Anal Fissure

Abstract

Background: Chronic anal fissure, a painful tear in the anal lining, often requires intervention when conservative treatment fails. This study compares the short-term outcomes and complications of lateral internal sphincterotomy (LIS), the gold standard, with Botox injection to inform optimal treatment choices. Methods & Materials: This descriptive longitudinal study was conducted in the Department of Surgery, Bangladesh Medical College Hospital, Dhaka, from July 2015 to December 2015. Patients with chronic anal fissures, attending the surgical outpatient department were considered as the study population. 50 adult patients; 25 in two groups. Data; analysis was done by SPSS version 22. Result: In this study of 50 patients (25 in each group), the mean maximal squeeze pressure was significantly higher in the LIS group (117.41 ± 32.31 mmHg) than in the Botox group (70.52 ± 27.52 mmHg; p < 0.001). However, LIS was associated with higher complication rates, including itching in 9 patients (36.0%) vs. 2 (8.0%) in the Botox group (p = 0.016), flatus incontinence in 4 patients (16.0%) vs. none (p = 0.037), and fecal incontinence in 3 (12.0%) vs. 1 (4.0%) patient (p = 0.297). Conclusion: Lateral internal sphincterotomy (LIS) is more effective than Botox for short-term pain relief and healing of chronic anal fissures but carries a higher risk of complications, including incontinence. Botox is safer with fewer side effects but may be less effective and require repeat treatments.