A comparative study of the results of the lateral internal anal sphincterotomy vs manual dilatation of anus for chronic anal fissure.

Objectives: To compare the results of surgical treatment of chronic anal fissure after lateral internal sphincterotomy with manual dilatation of anus. Study Design: Randomized Controlled Prospective study. Setting: Department of Surgery District Teaching Hospital Sargodha, Pakistan. Period: April 2018 to Feb 2019. Material & Methods: Patients were divided into two groups by lottery method. The procedures were performed using standard protocols after obtaining written informed consent. 50 patients underwent lateral internal anal sphincterotomy (Group 1) and 50 patients manual dilatation of anus (Group 2). Patients having atypical anal fissures associated with other diseases were excluded from this study. We assessed both groups for persistence of symptoms, complications and better satisfaction in terms of surgical techniques. Results: All patients became symptoms free within 07-14 days of surgery. Urinary retention was noted in 2(4%) patients in lateral internal sphincterotomy and 2(4%) in manual dilatation of anus. Temporary flatus Incontinence was noted in 2(4%) patient of lateral internal sphincterotomy and 2(4%) in manual dilatation of anus. Faecal soiling was observed in 1(2%) patient of lateral internal sphincterotomy. No recurrence, anal stenosis, hemorrhage, infection of wound, pain and bleeding associated with defecation was seen in both groups. Conclusion: Both lateral internal sphincterotomy and manual dilatation of anus techniques are effective.

Anatomical and Sexual Functions at Post Neovagina operation on Mayer Rokitansky Kuster Hauser Syndrome (MRKH) Patients with Sigmoid ,Amnion and Conventional Methods in Dr. Soetomo Hospital

ABSTRACT Background: The Mayer–Rokitansky–Kuster–Hauser (MRKH) syndrome is congenital malformation due to utero‐vaginal agenesis. For many years Dr Soetomo Hospital has been applying McIndoe technique using biomaterial amnion. Recently, in collaboration with digestive surgery, neovagina operation using sigmoid was performed. However, no data are available on the complications, anatomic, and functional results of the neovagina operation using sigmoid and amnion. Methods: MRKH patients who have performed neovagina operations from January 2011 to December 2014 were involved in this case review. The anatomical function was measured based on minimal vaginal length of more than 6 cm and width of 3 cm, while sexual performance is measured by Female Sexual Function Index (FSFI), which is above 23, and Female Sexual Distress Score Revised (FSDSR), whose score is < 11. Result: In 4 years period, there were 6 cases of MRKH underwent neovagina (1 used sigmoid and 5 used amnion) at Dr Soetomo Hospital. All of them had a satisfying anatomical and sexual function. Even though neovagina operation significantly reduces sexual distress, but it does not necessarily mean alleviate as seen by the high FSDSR score. Neovagina using amnion has faster operation time and cheaper with the same length of hospital stay than sigmoid neovagina. Sigmoid neovagina has a better vaginal length, lubrication and no need dilatation after operation, but it has higher complication risk. Conclusion: The Neovagina technique should be used at Soetomo Hospital depends on patient wishes and circumstances. For those who have strong financial support and are not willing to do manual dilatation, they should use the sigmoid neovagina, while those who are able to do manual dilatation, then the amnion neovagina is a good choice.Keywords: Neovagina, MRKH, sigmoid, amnion, anatomic function

Conservative Management of Anal Fissures

Background: Anal fissures are common, but most are short lived and heal spontaneously. Those which persist and require intervention cause considerable morbidity in an otherwise healthy young population. Glyceryl trinitrate is well in the conservative management of anal fissures. Material and Methods: The retrospective study was carried at Sher-i-Kashmir Institute of Medical Science Srinagar, Kashmir, India from Jan. 2005 to Dec. 2005. Total of 111 patients were studied, to evaluate the result of glyceryl trinitrate treatment in the management of anal fissures. Results: 80% of the fissures healed with topical glyceryl trinitrate treatment over a period of 6-8 weeks, with no recurrence during a one year follow up. The remaining 20% patients had to be managed with manual dilatation (8 patients) and lateral internal sphincterotomy (14 patients). Conclusion: Our conclusion is that glyceryl trinitrate induces a chemical sphincterortomy and produces healing of fissure in majority of patients. J Med Sci 2009;12(1):11-13.