A Prospective study to evaluate Medical Management vs Surgical Intervention in anal fissure
Abstract
Introduction: Anal fissure is a commonly encountered problem for surgeons. It is a longitudinal tear in distal anal canal with or without an ulcer. It causes significant changes in quality of life. This study was done to compare the efficacy of medical management and surgical intervention in cases of anal fissures.Methods: 50 patients were divided into two groups of 25 each. Group A patients were treated with topical application of 2% diltiazem gel and Group B patients were treated with Lateral sphincterotomy. Both groups were examined weekly for 4 weeks for pain using VAS score and at 12 weeks for healing.
Results: 21(84%) patients were pain free after 4 weeks under Group A, 24 (96%) patients were pain free after 4 weeks under Group B. 22(88%) patients were completely healed at 12 weeks under Group A, 25(100%) patients were completely healed at 12 weeks under Group B.
Conclusion: Lateral sphincterotomy can be advocated as treatment of choice for anal fissures. It has better pain relief and healing rates compared to topical application of 2% diltiazem gel. Medical Management can be used in patients refusing surgery or unfit for surgery.
References
1. Scouten WR et al. Ischemic nature of anal fissure. British Journal of Surgery. 1996; 83: 63-65.
2. Adriano Tocchi, Gianluca Mazzoni, Michelangelo Miccini, Diletta Cassini, Elia Bettelli, Stefania Brozzetti. Total lateral sphincterotomy for anal fissure. International Journal of Colorectal Disease. 2004; 19(3): 245-49.
3. Madalinski MH. Identifying the best therapy for chronic anal fissure. World J Gastrointest Pharmacol Ther. 2011;2:9-16.
4. Lund JN, Scholefield JH. Aetiology and treatment of anal fissure. Br J Surg. 1996;83:1335-44.
5. Ayantunde AA, Debrah SA. Current concepts in anal fissures. World J Surg. 2006;30:2246-60.
6. Cross KL, Massey EJ, Fowler AL, Monson JR; ACPGBI. The management of anal fissure: ACPGBI position statement. Colorectal Dis. 2008;10 Suppl 3:1-7.
7. Wald A, Bharucha AE, Cosman BC, Whitehead WE. ACG clinical guideline: management of benign anorectal disorders. Am J Gastroenterol. 2014;109:1141-57.
8. Hananel N, Gordon PH. Re-examination of clinical manifestations and response to therapy of fissure-in-ano. Dis Colon Rectum.1997;40:229-33.
9. Jonas Marion, Scholefield JH. Taylor I, Johnson CD. Recent advances in Surgery. 24th Edition. Churchill Livingstone; 2001. Anal fissure and chemical sphincterotomy; p. 115.
10. Poh A, Tan KY, Seow-Choen F. Innovations in chronic anal fissure treatment: A systematic review. World J Gastrointest Surg. 2010;2:231–41.
11. Jonas M, Speake W, Scholefield JH. Diltiazem heals glyceryl trinitrate-resistant chronic anal fissures: a prospective study. Dis Colon Rectum. 2002;45:1091–1095.
12. Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res (Hoboken). 2011;63:Suppl 11:S240-S252.
13. John Goligher, Anal Fissure, John Goligher, Surgery of the Anus, Rectum & Colon. AITBS, 5th Edition, 1992, 150.
14. Udwadia T.E., The prophylaxis of fissure in ano. Indian Journal of Surgery. 1978; 40(11): 560.
15. Jiang JK, Chiu JH, Lin JK. Local thermal stimulation relaxes hypertonic anal sphincter: evidence of somatoanal reflex. Dis Colon Rectum. 1999;42:1152-9.
16. Carapeti EA, Kamm MA, Evans BK, Phillips RK. Topical diltiazem and bethanechol decrease anal sphincter pressure without side effects. Gut. 1999;45:719-22.
17. Kumar Y, Kumar P. Lateral Internal Sphincterotomy Versus 2% Diltiazem Gel Local Application: A Comparative Study in Treatment of Chronic Fissure in Ano. Indian J Appl Res. 2018:8.
18. UK Srivastava, BK Jain, Praveen Kumar, Yusuf Saifee. A comparison of the effects of Diltiazem and Glyceryl trinitrate ointment in the treatment of chronic anal fissure: a randomized clinical trial. Surgery Today. 2007;37(6): 482-85.
19. R Dasgupta, I Franklin, J Pitt, PM Dawson, Successful treatment of chronic anal fissure with Diltiazem gel. Colorectal Disease. 4: 20-22.
20. Antropoli, C., Perrotti, P., Rubino, M. et al. Nifedipine for local use in conservative treatment of anal fissures. Dis Colon Rectum 42, 1011–1015 (1999).
21. Motie, M.R. and Hashemi, P., 2016. Chronic anal fissure: a comparative study of medical treatment versus surgical sphincterotomy. Acta Medica Iranica, pp.437-440
22. Sileri P, Stolfi VM, Franceschilli L, Grande M, Di Giorgio A, D’Ugo S, D’Eletto M, Gaspari AL., 2010. Conservative and surgical treatment of chronic anal fissure: prospective longer term results. Journal of Gastrointestinal Surgery, 1;14(5):pp.773-80.
23. Arthur JD, Makin CA, El-Sayed TY, Walsh CJ. A pilot comparative study of fissurectomy/diltiazem and fissurectomy/botulinum toxin in the treatment of chronic anal fissure. Tech Coloproctol. 2008 Dec;12(4):331-6; discussion 336.
2. Adriano Tocchi, Gianluca Mazzoni, Michelangelo Miccini, Diletta Cassini, Elia Bettelli, Stefania Brozzetti. Total lateral sphincterotomy for anal fissure. International Journal of Colorectal Disease. 2004; 19(3): 245-49.
3. Madalinski MH. Identifying the best therapy for chronic anal fissure. World J Gastrointest Pharmacol Ther. 2011;2:9-16.
4. Lund JN, Scholefield JH. Aetiology and treatment of anal fissure. Br J Surg. 1996;83:1335-44.
5. Ayantunde AA, Debrah SA. Current concepts in anal fissures. World J Surg. 2006;30:2246-60.
6. Cross KL, Massey EJ, Fowler AL, Monson JR; ACPGBI. The management of anal fissure: ACPGBI position statement. Colorectal Dis. 2008;10 Suppl 3:1-7.
7. Wald A, Bharucha AE, Cosman BC, Whitehead WE. ACG clinical guideline: management of benign anorectal disorders. Am J Gastroenterol. 2014;109:1141-57.
8. Hananel N, Gordon PH. Re-examination of clinical manifestations and response to therapy of fissure-in-ano. Dis Colon Rectum.1997;40:229-33.
9. Jonas Marion, Scholefield JH. Taylor I, Johnson CD. Recent advances in Surgery. 24th Edition. Churchill Livingstone; 2001. Anal fissure and chemical sphincterotomy; p. 115.
10. Poh A, Tan KY, Seow-Choen F. Innovations in chronic anal fissure treatment: A systematic review. World J Gastrointest Surg. 2010;2:231–41.
11. Jonas M, Speake W, Scholefield JH. Diltiazem heals glyceryl trinitrate-resistant chronic anal fissures: a prospective study. Dis Colon Rectum. 2002;45:1091–1095.
12. Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res (Hoboken). 2011;63:Suppl 11:S240-S252.
13. John Goligher, Anal Fissure, John Goligher, Surgery of the Anus, Rectum & Colon. AITBS, 5th Edition, 1992, 150.
14. Udwadia T.E., The prophylaxis of fissure in ano. Indian Journal of Surgery. 1978; 40(11): 560.
15. Jiang JK, Chiu JH, Lin JK. Local thermal stimulation relaxes hypertonic anal sphincter: evidence of somatoanal reflex. Dis Colon Rectum. 1999;42:1152-9.
16. Carapeti EA, Kamm MA, Evans BK, Phillips RK. Topical diltiazem and bethanechol decrease anal sphincter pressure without side effects. Gut. 1999;45:719-22.
17. Kumar Y, Kumar P. Lateral Internal Sphincterotomy Versus 2% Diltiazem Gel Local Application: A Comparative Study in Treatment of Chronic Fissure in Ano. Indian J Appl Res. 2018:8.
18. UK Srivastava, BK Jain, Praveen Kumar, Yusuf Saifee. A comparison of the effects of Diltiazem and Glyceryl trinitrate ointment in the treatment of chronic anal fissure: a randomized clinical trial. Surgery Today. 2007;37(6): 482-85.
19. R Dasgupta, I Franklin, J Pitt, PM Dawson, Successful treatment of chronic anal fissure with Diltiazem gel. Colorectal Disease. 4: 20-22.
20. Antropoli, C., Perrotti, P., Rubino, M. et al. Nifedipine for local use in conservative treatment of anal fissures. Dis Colon Rectum 42, 1011–1015 (1999).
21. Motie, M.R. and Hashemi, P., 2016. Chronic anal fissure: a comparative study of medical treatment versus surgical sphincterotomy. Acta Medica Iranica, pp.437-440
22. Sileri P, Stolfi VM, Franceschilli L, Grande M, Di Giorgio A, D’Ugo S, D’Eletto M, Gaspari AL., 2010. Conservative and surgical treatment of chronic anal fissure: prospective longer term results. Journal of Gastrointestinal Surgery, 1;14(5):pp.773-80.
23. Arthur JD, Makin CA, El-Sayed TY, Walsh CJ. A pilot comparative study of fissurectomy/diltiazem and fissurectomy/botulinum toxin in the treatment of chronic anal fissure. Tech Coloproctol. 2008 Dec;12(4):331-6; discussion 336.
Published
2023-08-15
How to Cite
AGRAWAL, Puneet et al.
A Prospective study to evaluate Medical Management vs Surgical Intervention in anal fissure.
J Soc Surg Nep, [S.l.], v. 26, n. 1, p. 11-15, aug. 2023.
ISSN 2392-4772.
Available at: <https://jssn.org.np/index.php?journal=jssn&page=article&op=view&path%5B%5D=519>. Date accessed: 22 sep. 2023.
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Original Article
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