A Comparison of Surgical Sphincterotomy and Medical Treatment for Chronic Anal Fissure

Abstract

BACKGROUND:
An anal fissure is one of the common anorectal diseases resulting from a split or tear in the anal canal's skin, it causes pain, bleeding, and emotional stress. The occurrence of anal fissures is a common medical problem that affects both sexes equally. Anal fissures are longitudinal or elliptical tears or ulcers in the distal anal canal, extending below the dentate line to the anal verge. Anal fissures are common in people of all ages, especially teenagers and young adults. Some studies suggest that as many as one in five persons develop fissures during their lifetime. Anal fissures occur predominantly in the midline and most commonly 90% are located posteriorly and 10% anteriorly. After childbirth, women tend to develop anterior fissures; less than 1% of patients have fissures both in anterior and posterior positions. Most anal fissures are acute and resolve spontaneously or with conservative medical management in 10–14 days. It takes 6–8 weeks for the actual tear to heal. Fissures that fail to heal become chronic.
AIM: To determine whether the medical Treatment of anal fissures can be an effective alternative to surgery. The aim of the present study was to compare the efficacy of diltiazem and nitroglycerin topical ointments with surgical lateral internal sphincterotomy.
MATERIAL AND METHOD:
This Retrospective study was conducted under the Department of General surgery. Based on the selection criteria 80 patients attending general surgery OPD having anal fissure were screened for eligibility, and all those 60 who fulfilled the inclusion criteria were eligible to participate in the study. The purpose of the study was explained to patients. Informed written consent was taken prior to the actual participation of the patient in the study. After admission, short history was taken and a physical and clinical examination was conducted on each patient admitted to the surgery department with features of the perianal fissure. Informed written consent was taken from the patients or their guardians willing to participate in the study.
RESULTS:
Response to treatment (both pain relief and fissure healing) was not seen in 15 patients of group A five people did not want to continue medical treatment and underwent surgery. seven patients who received medical treatment, after three months follow up, in five patients the pain disappeared. The pain continued for two people who were treated surgically. In group B, there were 10 patients without response until 3 months of follow-up, of whom 6 people had pain relief finally and the other 3 underwent surgery voluntarily. All people in group C had complete pain relief, but fissure healing was not completed in 3 people until month 3.
CONCLUSION:
In conclusion the recent developments in the treatment of chronic anal fissures, it is possible to draw the conclusion that conservative treatments such as those involving lignocaine, nitroglycerine, botulin toxin, or oral nifedipine are all effective methods that may reduce the need for anesthesia and surgery in a significant number of patients. Despite good responses to medical treatment, surgical treatment was the more effective medical treatment of choice for patients who are willing to have surgery.
KEYWORDS: Anal fissure; Diltiazem ointment; Nitroglycerin; Lateral internal sphincterotomy, Anal dilatation, Diltiazem, Chronic anal fissure, Clinical trial.