Comparison of Outcome in Lateral Sphinterotomy and Anal Advancement Flap

  • Rehman Maqbool Medical Officer Madina Teaching Hospital, Faisalabad
  • Abdullah Bin Saeed Senior Registrar, S-II Allied Hospital, Faisalabad
  • Ahmad Raees Medical Officer H# 264-F Millat Town, Faisalabad
  • Javed Iqbal Professor of Surgery / Project Director FMU/Allied Hospital, Faisalabad
Keywords: Anal fissure, lateral sphincterotomy, Anal Advancement Flap, outcome


Background: Surgery should be reserved for patients in whom anal fissures fail to heal despite adequate medical therapy. The goal of surgical therapy is to relax the internal anal sphincter, which is most often accomplished by a lateral internal sphincterotomy. An anal advancement flap is effective in healing an anal fissure as primary line of treatment is also a better choice for those who have recurrent anal fissures. Objective: The objective of this study was to compare the outcome of lateral sphincterotomy with Anal Advancement Flap in patients of anal fissure. Setting: Department of Surgery, Punjab Medical College and Affiliated Hospitals, Faisalabad. Study design: Randomized clinical trial. Duration of study:  6 months, from 01-03-2016 to 31-8- 2016. Subjects and Methods:  A total of 160 cases (80 cases in each group) were included in the study. After taking hospital ethical committee approval, patients coming through OPD, who fulfilled the inclusion criteria were enrolled and informed consent was taken from them. All the patients were randomly divided into two groups by using computer generated number table. Group A patients underwent lateral sphincterotomy and group B patients underwent anal advancement flap procedure for chronic Anal Fissure. Outcome in terms of Wound infection and anal incontinence was compared in both groups. Results: In our study, mean age was calculated as 36.45+9.68 in group A and 38.61+9.77 years in group B, 56.25(n=45) in Group-A and 57.5%(n=46) in Group-B were male while 43.75%(n=35) in Group-A and 42.5%(n=34) in Group-B were females, comparison of outcome of lateral sphincterotomy with anal advancement flap in patients of anal fissure shows that 12.5%(n=10) in Group-A (patients who underwent lateral sphincterotomy) and 3.75%(n=3) in Group-B (patients who underwent anal advancement flap procedure)  had infection, p value = 0.01 while anal incontinence was recorded as 17.5%(n=14) in Group-A and 2.5%(n=2) in Group-B, p value = 0.001. Conclusion: We concluded that outcome of anal Advancement flap is significantly better when compared with lateral sphincterotomy in treatment of chronic anal fissure in term of less infection and anal continence.

How to Cite
Maqbool, R., Saeed, A. B., Raees, A., & Iqbal, J. (2017). Comparison of Outcome in Lateral Sphinterotomy and Anal Advancement Flap. Annals of Punjab Medical College, 11(2), 136-140.