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Management of Anal Fissure

Dr. Navaneethakrishnan and Dr. Shanmuga Sankar Ram

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In our experience of more than 10,000 cases of anal dilatation for the past more than 25 years since 1971 to till date, simple anal dilatation has been effective. The procedure of anal dilatation is much simpler than Lords and it is purely an outpatient procedure. Under short GA anal canal and the lower rectum are dilated by introducing two fingers in the 12 o clock and two fingers of the other hand in the 6 o clock position and dilate for one minute. Then the position of the fingers is changed into 3 & 9 o clock position and dilate for another one minute. The pressure should be maintained through out for two minutes.

Postoperatively we allow the patient to take normal diet with high residue like banana and greens so that the patient passes free soft bulky motion which automatically dilates the anal canal periodically. For the first 3 to 4 days we advice to take laxative like liquid paraffin one Oz at bedtime to avoid constipation.

This anal dilatation may help in rupturing the fibrous band known as Pecton Band As per MILES Theory, which was present just above the Hiltons line. This is nothing but the fibrous band V sub mucous fibrosis due to congestion of the hemorrhoid veins and super added infection. As per the Lord!|s procedure neither periodic dilatation by the surgeon nor self-dilatation by the patient. is not required, since we are commencing the high residue diet in the same day or the first postoperative day resulting the soft bulky motion will acts as a natural dilator. None of our patients developed incontinence postoperatively and a small percentage developed recurrence due to the negligence of the advised dietary regime and developed constipation.

To Conclude:

With our vast experience we have found that,

  1. It is purely an out patient procedure and the patient is fit for normal routine work within 2 to 3 days.
  2. No further hospital visit is required for periodic dilatation as per Lord’s procedure.
  3. No complication like anal incontinence.
  4. Postoperative pain is either absent or minimum when anal dilatation is performed as an adjuvant procedure for hemorrhoids and perianal abscess.

This lecture was delivered for M S General Surgery Postgraduates of Karnataka and and practicing Surgeons in Bangalore at Manipal Hospital Bangalore on March 2000 Under the presidenship of Dr.M.G.BHAT


This lecture was delivered for M S General Surgery Postgraduates of Karnataka and and practicing Surgeons in Bangalore at Manipal Hospital Bangalore

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