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A Randomised Study Comparing Topical Glyceryl Trinitrare, Anal Dilatation and Lateral Sphincterotomy for the Treatment of Chronic Anal Fissure

Nikhil Chauhan , Suman Parihar1 , Nikhil Chauhan2 , JL Kumawat3

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New Indian Journal of Surgery 10(5):p 526-531, September-October 2019. | DOI: DOI: https://dx.doi.org/10.21088/nijs.0976.4747.10519.10

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Suman Parihar, Nikhil Chauhan, JL Kumawat. A Randomised Study Comparing Topical Glyceryl Trinitrare, Anal Dilatation and Lateral Sphincterotomy for the Treatment of Chronic Anal Fissure. New Indian J Surg. 2019;10(5):526-531.

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Abstract

Background: Anal fissure is a common and minor disorder that needs careful attention because it is a painful condition but the treatment is simple and effective. This has led to the investigation of nonsurgical treatment options that avoid permanent damage to the internal anal sphincter. Methods: The study was conducted in Geetanjali Medical College and Hospital from year 2015 to 2017, with chronic anal fissure. A comparative study of 101 cases was done between different modalities in the treatment of anal fissure. Study cases were divided into 3 groups. Treated with topical application of 0.2% glyceral trinitrate GTN, Treated with anal dilation under G.A. or spinal anaesthesia, Treated with lateral sphincterotomy under total intravenous anesthesia (T.I.V.A.) or spinal anaesthesia (S.A.). Results: A follow up of 101 patients was done for 6 weeks. 30 to 50 years of age with male and female ratio of 2.48:1. Complains of pain in anal region during defecation with blood streak on stool. History of constipation was presented in 71% patients. Out of 101 patients 81 patients could be followed up to 6 weeks. 20 lost were belonging to GTN group. 100% and 93.3% patients were relieved of pain in anal dilatation and lateral sphincterotomy as compared to 75% patients with GTN application (significant; p<0.001). Conclusion: This study concludes that pain relief is early with lateral sphincterotomy anal dilatation. Healing of fissures was early and 100% by lateral sphincterotomy only. Postoperative stay in hospital was short. Incidence of anal incontinence were present with anal dilatation and lateral sphincterotomy which was absent with GTN. Also, healing of fissure was seen in 70% patients at 6 weeks after GTN application. Lateral sphincterotomy is the best choice in terms of surgical treatment but GTN application is a good medical treatment in majority of patients and surgery can be offered to those failures with medical treatment.

Keywords: Fissure in ano; Sphincterotomy; Anal dilatation; Anal incontinence.

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Suman Parihar, Nikhil Chauhan, JL Kumawat. A Randomised Study Comparing Topical Glyceryl Trinitrare, Anal Dilatation and Lateral Sphincterotomy for the Treatment of Chronic Anal Fissure. New Indian J Surg. 2019;10(5):526-531.

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DOI: DOI: https://dx.doi.org/10.21088/nijs.0976.4747.10519.10

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