Surgical management of anal fissure versus Glyceryl Trinitrate ointment: a comparative prospective study

Abstract

Background: Anal fissure is common condition in general population which cause severe pain at the anal region while defecation and associated with bleeding. These symptoms cause reduction in quality of life with considerable morbidity. The objective of this study was to compare the difference in outcome between open lateral anal sphincterotomy and application of topical 0.2% nitroglycerin ointment for the treatment of chronic anal fissure and their individual efficacy.Methods: 68 cases with a clinical diagnosis of anal fissure were recruited in the study. All selected patients met with inclusion criteria. Thus, selected cases were assigned to one of the other groups by odd and even method. Group A was managed conservatively using topical 0.2% nitroglycerin ointment, whereas Group B underwent open lateral anal sphincterotomy. Both groups were followed up at 3 week, 6 weeks, and 12 weeks, after the treatment.Results: Among all the 68 patients, all patients had come with complaint of pain whereas 31 patients had bleeding per rectum along with pain. On clinical examination, hypertonic anal sphincter elicited in 47 patients, sentinel skin tag was noted in the 23 patients. Group A included 34 patients treated with topical 0.2% nitroglycerin ointment and group B included 34 patients who underwent lateral internal sphincterotomy. In group A, 25 (73.5%) patients treated successfully, 9 (26.4%) patients were uncured who underwent lateral anal sphincterotomy, with no fresh complaints during follow up. By contrast, all patients in group B were successfully treated and only one (0.03%) patient came with unexplained discomfort and one patient suffered from flatus incontinency.Conclusions: This prospective study, demonstrates that open lateral internal sphincterotomy is superior to topical nitroglycerin application in the treatment of anal fissure with good symptomatic relief, high rate of healing with very low rate of early incontinence. Patients who are not willing to undergo surgery the glycerin trinitrate ointment can be used as medical line for fissure in ano.

A comparison of efficacy between 0.2% of topical glyceryl trinitrate and lateral anal sphincterotomy

“…In the present study 37 patients were male and 23 patients were female and there is more predilection for males. This is comparable to the studies done by Yetisir et al, Reddy et al and Tauro et al [12][13][14] In this study common age group affected was 40 to 50 years and the study done by Yetisir et al, Reddy et al their age group affected was 30 to 40 years. 12,13 Most common location was posterior (53) followed by anterior (5) and both (2).…”

“…14 In the study by Reddy et al it was 11.76%. 12 Post-operative pain was noticed in 33.33% of cases in the present study, haemorrhage in 6.66% and seroma in 3.33%. In the study conducted by Ananadaravi et al pain is seen in 14% patients, haemorrhage in 20% patients and seroma in 2% patients.…”

Multispectroscopic DNA interaction and Docking studies

“…The Stern–Volmer quenching constant was obtained from the classical Stern–Volmer Equation, I 0 /I=1+K.r . ( I 0 and I are the fluorescence intensities in the absence and presence of the complexes, respectively, K is a linear quenching constant, which depends on the concentration ratio of bound EB to DNA, and r is the concentration ratio of the complex to DNA …”

Box–Behnken design for the optimisation of Kabachnik–Fields reaction catalysed by natural kaolinite clay under eco-friendly conditions

“…The Kabachnik-Fields reaction 7 is the most efficient method for the synthesis of α-aminophosphonates, using various titanium-based catalysts, 8,9 silver, 10 indium, 11 copper, 12 bismuth, 13,14 zirconium, 15,16 cobalt, 17 iron 18 and nickel. 19 In addition to transition metals, rare earths have also been used to synthesise these molecules; Jang et al developed a one-pot, three-component synthesis of α-aminophosphonates using Yb (OTf) 3 as a Lewis acid catalyst.…”