“Needle-in-Groove” Technique: A Safer Modification for Subcutaneous Lateral Internal Sphincterotomy (SLIS)

Abstract Background Anal fissure is one of the most common and painful proctologic diseases. An anal fissure is a split in the mucosa extending from the anal verge towards the dentate line. All methods of treatment aim to reduce the anal sphincter spasm associated with chronic anal fissures. Lateral internal sphincterotomy remains the surgical treatment of choice for many practitioners. Although sphincterotomy is very successful at healing these fissures it requires an operation with associated morbidity. Aim We present a modification of subcutaneous lateral internal sphincterotomy (SLIS) which ensures that the blade is introduced through the proper plane over a pre-placed guiding needle and seems to improve the safety without compromising the efficacy of the procedure Material and Methods This was a prospective study conducted in a teaching hospital over a period of four years in patients with chronic anal fissures. After an informed consent all procedures were done under local anesthesia as office procedure. Patients were followed up as at 6 weeks, 3 month, 6 month and a year after procedure and assessed for relief in symptoms, healing of fissure or any incontinence Results One hundred and fifty six patients underwent the procedure. Significant symptom relief was reported in all patients with overall fissure healing rate of 98.5%. Recurrence of fissure within 1 year of follow up was seen in 3 patients. Most of the complications in our study were minor. Two of our patients reported new onset incontinence to flatus on first follow up which resolved within 6 months. Conclusion Surgical sphincterotomy is one of most effective modality for anal fissures particularly the chronic ones. Needle in groove technique is a very safe and effective operative modification of SLIS. Key Message The primary goal of all therapeutic measures in chronic anal fissure management is to break the vicious circle of inflammation, pain and internal sphincter spasm. The optimal therapy should be safe as well as successful as far as healing and continence are concerned. We believe that this modification is a step in that direction