COMPARISON OF LASER AND CONVENTIONAL OPEN LATERAL INTERNAL SPHINCTEROTOMY IN PATIENTS WITH CHRONIC ANAL FISSURE: A RANDOMIZED CONTROLLED TRIAL

Abstract

Objective: To compare postoperative outcomes between laser, lateral internal sphincterotomy (LIS) and conventional open LIS in patients with chronic anal fissure. Methods: This prospective randomized controlled trial was conducted at SIMS Hospital & Research Center, Swat, over 12 months. Eighty patients diagnosed with chronic anal fissure were randomized into two groups: Laser LIS (n=40) and Open LIS (n=40). Primary outcome was postoperative pain assessed using Visual Analogue Scale (VAS) at 24 hours and Day 7. Secondary outcomes included operative time, healing rate at 4 weeks, postoperative complications, Wexner incontinence score, hospital stay, and time to return to normal activity. Statistical analysis was performed using independent sample t-test and Chi-square test. Results: Mean VAS at 24 hours was significantly lower in the Laser group (4.28 ± 1.00) compared to the Open group (5.97 ± 1.20) (p < 0.001). At Day 7, Laser group continued to demonstrate significantly lower pain scores (2.01 ± 0.80 vs 3.47 ± 1.00; p < 0.001). Operative time was shorter in the Laser group (18.2 ± 3.0 minutes vs 25.76 ± 4.0 minutes; p < 0.001). Healing at 4 weeks was 95% in the Laser group and 85% in the Open group (p = 0.18). Mean Wexner score was significantly lower in the Laser group (0.46 ± 0.70 vs 1.53 ± 1.00; p < 0.001). Hospital stay and return to work were significantly reduced in the Laser group (p < 0.001). Conclusion: Laser lateral internal sphincterotomy demonstrated reduced postoperative pain, shorter operative time, improved short-term continence, and faster recovery compared to conventional open LIS, with comparable healing rates.