Morbidity associated with treatment of chronic anal fissure

Abstract

Objective: To assess the effectiveness of different modes of treatment of chronic anal fissure as regards improvement of symptoms and complications. Methods: This prospective study included 129 consecutive patients with chronic anal fissures presented to the Surgical Outpatients’ Department of Islam Teaching Hospital Sialkot, Pakistan; from September 2010 to November 2012. Patients were distributed in three groups. In “OBG group”, patients had attended Gynae/Obs OPD and got treated and were then referred to surgical OPD for failure of treatment or recurrence. Patients who presented with history of treatment by GPs were included in “GP Group” “SGR Group” included those who directly reported to surgical OPD for treatment. Patients were managed both pharmacologically as OPD patients and surgically as admitted patients. Patients were instructed to apply small amounts of 0.2% GTN paste in soft white paraffin, to the anoderm with finger tips three times a day. Patients were evaluated at two-week intervals and at each visit the symptoms control, adverse effects and fissure status were recorded. If there was symptomatic relief or the fissure healing was in progress, the treatment was continued for a total duration of eight weeks. Operated patients were nursed in wards after surgery i.e Internal Anal Sphicterotomy. They were advised to report to OPD weekly for one month or earlier if they experienced any symptoms suggestive of complications. Patients were declared cured in case of complete symptomatic relief with fissure healing. Success, failure and associated problems were recorded and analysed to get results. Results:This study included 129 patients who could be followed up for a minimum of three months. These patients were referred by gynaecologist i.e. 22 (17%) for treatment failure while 5 patients with wrong diagnosis were not included in statistical analysis; similarly 41 (32%) patients were referred by general practitioners and 9 patients with wrong diagnosis were excluded. Sixty six patients i.e. 51% were those who directly reported to surgical OPD and had no previous treatment. With surgical treatment, pain, bleeding per rectum and constipation showed significant improvement as compared to GTN ointment application. Fissure healing was 100% in surgical group as compared to 74% in medical group. Complications were recorded and were found to be headache with medical treatment; while the most feared complication with surgical treatment i.e. permanent incontinence was not encountered in our study. Conclusion: Topical glyceryl trinitrate is economical, has a good healing rate, and faecal incontinence has not been reported. Its effectiveness, however, depends on patients’ compliance which may be poor in view of associated headaches and a local burning sensation. It is first line of treatment for anal fissure but lateral internal sphincterotomy is superior, more effective and curative than the chemical sphincterotomy. Surgery is reserved for people with anal fissure who have tried medical therapy for at least one to t...

Lateral Internal Anal Sphincterotomy of Chronic Anal Fissure: An Experience of 165 Cases

“…In the current study, the mean age was 29.16 years while male to female ratio was 1.2 :1 with a slight predominance of men; this is because most female patients attend gynecology clinics due to religious and cultural habits and it is compatible with a study done by Latif et al in 2013, which had a mean age of 30 years and male to female ratio of 1.8:1 [11].…”

Prospective multicenter observational trial on the safety and efficacy of LEVORAG® Emulgel in the treatment of acute and chronic anal fissure

“…Furthermore, most of the myorelaxant creams available (containing nitric oxide donors) have some unpleasant side effects like headache, migraine and pruritus ani [ 7 , 11 ], which affect patients’ compliance, while other myorelaxants with few side effects (calcium channel blockers) are not available in our country. On the other hand, LIS, which is necessary in about one-third of AF patients [ 1 ] can rapidly relieve symptoms, but the risk of early or late fecal incontinence [ 12 ], even if low, prevents its application as a first line therapy.…”

Scanner-Assisted CO2 Laser Fissurectomy: A Pilot Study

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