Comparative Short-Term Results of Open versus Closed Techniques: An Approach towards Internal Lateral Sphincterotomy in Yaoundé

The purpose of this study was to compare the post-operative results of open and closed internal lateral sphincterotomies in the short and medium term.

We carried out a prospective randomized comparative study in the digestive and visceral surgery departments of Central Hospital of Yaounde over a period of 15months. Patients were assessed for each approach based on a number of factors, including the length of surgery, post-operative discomfort, recurrence, surgical site infection, gas and/or stool incontinence, and healing time, with follow-up lasting up to 12 months.

A total of 63 patients underwent surgery within them we had 32 open lateral internal sphincterotomy (group 1) and 31 closed lateral internal sphincterotomy (group 2). There were 35 men and 28 women with a sex ratio of 1.25. The majority of fissures were located at the posterior commissure. The average duration of the procedure was longer in patients in group 1 (15.34 minutes) compared to 5.22 minutes in patients in group 2. In patients in group 1, we identified 3.12 percent of surgical wound infections, but none in group 2. Gas incontinence was found in 6.45% of group 2 patients and 28.12% of group 1 patients. The mean severity of pain in patients in groups 2 and 1 at 24 hours post-operative was between 4 and 6 on the visual analogue scale, and between 7 and 10 in group 1. In group I, wound healing took 8.9 days, while in group 2, it took 4 days. Both sets of patients spent 24 hours in the hospital. During the 6-month follow-up period, no recurrence was observed.

Because it is successful and linked with a lower complication rate than open sphincterotomy, closed lateral internal anal sphincterotomy is the therapy of choice for chronic anal fissures.