ĐẶC ĐIỂM LÂM SÀNG VÀ BIẾN CHỨNG SỚM SAU PHẪU THUẬT CẮT BÊN CƠ THẮT TRONG BẰNG DAO LIGASURE ĐIỀU TRỊ NỨT HẬU MÔN MẠN TÍNH TẠI BỆNH VIỆN TRƯỜNG ĐẠI HỌC Y DƯỢC CẦN THƠ

Abstract

Background: Anal fissure (fissure-in-ano) is a very common anorectal condition, characterized by the formation of deep mucosal tears in the anal canal, resulting in significant pain and considerable impairment in the patient's quality of life. Treatment of this condition includes medical treatment, minimally invasive procedures, and surgical interventions, with lateral internal sphincterotomy being regarded as one of the most effective procedures for chronic anal fissures unresponsive to conservative management. The application of the Ligasure device enhances hemostatic efficacy, minimizes tissue trauma, and reduces postoperative pain, providing particular benefit in patients with concomitant hemorrhoidal disease. Objectives: The study aims to describe clinical features and early complications of ligasure-assisted lateral internal sphincterotomy for chronic anal fissure at Can Tho University of Medicine and Pharmacy Hospital. Materials and methods: A prospective cross-sectional study was conducted on 34 patients with chronic anal fissure who underwent lateral internal sphincterotomy using Ligasure at Can Tho University of Medicine and Pharmacy Hospital between 2023 and 2025. Results: A total of 34 patients with chronic anal fissure were treated using lateral internal sphincterotomy with Ligasure. The mean age of the patients was 33.17 ± 10.9 years, with 44.1% being male and 55.9% female. The anal fissures were predominantly located at the posterior midline (6 o'clock position) in 76.5% of cases, at the anterior midline (12 o'clock position) in 2.9% of cases, and in both locations in 20.6% of cases. The edge of fissure was high in 34 cases (100%). Sentinel skin tag was found in almost all cases (85,3%), while hypertrophied anal papilla was found about 20.6% in all cases. Hemorrhoids and anal polyps associated with anal fissures accounted for 38,2% and 23,5% respectively. No serious complications were reported after surgery, although one case (2.9%) experienced urinary retention. All patients were discharged on the first postoperative day. Fissure healing rates were 91.2% after 4 weeks and 100% after 8 weeks. Conclusions: Lateral internal sphincterotomy using Ligasure is a modern, safe, and effective method for treating chronic anal fissures, particularly in patients with accompanying hemorrhoids. Thanks to its significant reduction in postoperative pain and minimal bleeding, this technique not only facilitates faster recovery but also enhances the overall quality of treatment.