Baranski, Gregg M, MD

Park, John S, MD

Yushuva, Arthur, MD

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksDepartment of SurgeryComparison of Wound Complications in Open vsClosed Lateral Internal Sphincterotomy for AnalFissure (Presentation)Gregg M. Baranski MDLehigh Valley Health Network, Gregg.Baranski@lvhn.orgArthur Yushuva MDLehigh Valley Health Network, Arthur.Yushuva@lvhn.orgJohn S. Park MDLehigh Valley Health Network, John_S.Park@lvhn.orgFollow this and additional works at: http://scholarlyworks.lvhn.org/surgeryPart of the Other Medical Specialties Commons, and the Surgery CommonsThis Presentation is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works byan authorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtBaranski, G., Yushuva, A., & Park, J. (2015, May 22). Comparison of Wound Complications in Open vs Closed Lateral InternalSphincterotomy for Anal Fissure. Presentation presented at: Schaeffer Research Day, Lehigh Valley Health Network, Allentown, PA.Park, J. S. (2016, May 2). Comparison of Wound Complications in Open vs Closed Lateral Internal Sphincterotomy for Anal Fissure.Presentation presented at: The 2016 ASCRS (American Society of Colon & Rectal Surgeons) Annual Scientific Meeting, Los Angeles,CA.Comparison of Wound Complications in Open vs Closed Partial Lateral Internal Sphincterotomy for Anal Fissure  Gregg M. Baranski, MD Arthur Yushuva, MD John S. Park, MD Background  Anal fissure: ulcer-like, longitudinal tear in the anal canal, distal to the dentate line  Presents as sharp rectal pain and bleeding associated with bowel movements  Trauma likely the inciting event  Hypertonia of internal anal sphincter  Diminished perfusion to anoderm  Rx: Over half of fissures heal with conservative measures  Persistent fissures require operative intervention  Purpose  Partial lateral internal sphincterotomy (PLIS) is considered the preferred surgical treatment for chronic anal fissure in most patients  PLIS can be performed by either the open or closed technique, with equivalent efficacy in fissure healing rates1-4    Few studies have specifically compared wound complication rates between the two techniques   Aim: compare the incidence of wound complications at the sphincterotomy site between open and closed technique   Methods  Retrospective chart review of patients in a single specialty practice undergoing open or closed PLIS for chronic anal fissure over a 5 year period  Total of 253 patients identified  88 had open sphincterotomy   165 had closed sphincterotomy    Preoperative variables:   Age   Gender  Location of fissure     Demographics Table 1: Open  (n = 88 pts) Closed  (n = 165 pts) Median Age 47.9 46.3 Gender Male 48 (54.6%) 87 (52.7%) Female 40 (45.4%) 78 (47.2%) Location Posterior 62 (70.5%) 120 (72.7%) Anterior 20 (22.7%) 32 (19.4%) Other 6 (6.8%) 13 (7.9%) Methods   Exclusion criteria:  Active infection at time of surgery  Inflammatory bowel disease  Lost to follow-up  Statistical analysis: Chi-square, Fisher’s exact test, Logistic regression  Results  Compared to closed sphincterotomy, open sphincterotomy had increased incidence of:  Wound infection  Return to operating room  Delayed healing  Fissure healing rate was equivalent with both techniques Results                         Table 2: Open  (n = 88 pts) Closed  (n = 165 pts)  p-value Odds ratio Infection 13 (14.8%) 4 (2.4%) 0.0002 0.141 Delayed Healing 27 (30.7%) 21 (12.6%) 0.0005 0.329 Re-operation 8 (9.1%)  3 (1.8%) 0.0183 0.185 Fissure Healed 82 (93.2%) 163 (98.8%) 0.0686 N/A A p-value of <0.05 was considered statistically significant Conclusions  Open and closed sphincterotomy have equivalent fissure healing rates, as has been shown previously1-4    In our study, the open technique appears to have a significantly higher wound complication rate, including higher incidence of surgical site infection and delayed wound healing  When technically feasible, closed sphincterotomy appears to be the preferred technique  Discussion  In general, our wound complication rates are higher than previously reported5-6  Retrospective study  Effect of wound complications on incontinence References 1. Nelson RL. Operative procedures for fissure in ano. Cochrane Database of Systematic Reviews. 2010; (1): CD002199 2. Wiley M, Day P, Rieger N, Stephens J, Moore J. Open vs closed lateral internal sphincterotomy for idiopathic fissure-in-ano: a prospective , randomized, controlled trial. Dis Colon Rectum. Jun 2004; 47(6): 847-52 3. Garcia-Aguilar J, Belmonte C, Wong WD, Lowry AC, Madoff RD. Open vs closed sphincterotomy for chronic anal fissure. Dis Colon Rectum. 1996; 39(4): 440-3 4. Kortbeek JB, Langevin JM, Khoo REH, Heine JA. Chronic fissure-in-ano: a randomized study comparing open and subcutaneous lateral internal sphincterotomy. Dis Colon Rectum. Sept 1992; 35(9): 835-7 5. Gupta V, Rodrigues G, Prabhu R, Ravi C. Open versus closed lateral internal sphincterotomy in the management of chronic anal fissures: a prospective randomized study. Asian J Surg. 2014; 37(4): 178-83 6. Kang GS, Kim BS, Choi PS, Kang DW. Evaluation of healing and complications after lateral internal sphincterotomy for chronic anal fissure: marginal suture of incision vs open left incision: prospective, randomized, controlled study.  Dis Colon Rectum. 2008; 51(3): 329-33  

Comparison of Wound Complications in Open vs Closed Lateral Internal Sphincterotomy for Anal Fissure (Presentation)

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Comparison of Wound Complications in Open vs Closed Lateral Internal Sphincterotomy for Anal Fissure (Presentation)

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