A Comparative Study To Evaluate The Effectiveness And Complications Associated With Topical Diltiazem Versus 0pen Partial Lateral Internal Anal Sphincterotomy For Chronic Anal Fissure.
Journal Title: IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) - Year 2018, Vol 17, Issue 9
Abstract
Background: Anal fissure is a one of the most common and painful benign anorectal disease and its clinical management is still controversial despite several systematic reviews. Chronic anal fissure is defined by a history of symptoms present for more than 2 months’ duration and with a triad of external skin tags, namely, a hypertrophied anal papilla, an ulcer with rolled edges, and a base exposing the internal sphincter. Because complications such as incontinence are associated with surgical treatment, chemical sphincterotomy is currently favored. Objectives: The objective of this study is to compare the difference in outcome between open partial lateral internal sphincterotomy and application of topical 2% diltiazem ointment for the treatment of chronic anal fissure. Methods: This was a quasi-experimental study carried out between August, 2016 and July, 2017 in the Upgraded Department of Surgery, Darbhanga Medical College & Hospital, Laheriasarai, Darbhanga, Bihar. Sixty consecutive cases with a clinical diagnosis of chronic anal fissure were recruited in the study. All recruited patients met the study inclusion criteria and were randomly assigned to one of the two groups. Group A was managed conservatively using topical 2% diltiazem ointment, whereas Group B underwent open partial lateral internal sphincterotomy. Both groups were followed up at 1 week, 2 weeks, 4 weeks, and 6 weeks after the treatment. Results: All the patients complained of pain. A total of 43 (71.7%) patients had pain with constipation, whereas 31 (51.7%) patients had bleeding per rectum. Upon clinically examining the anal area, tenderness was elicited in all 60 (100%) patients. Group A included 30 (11 females and 19 males) cases treated with topical 2% diltiazem ointment and Group B included 30 (11 females and 19 males) cases who underwent open partial lateral internal sphincterotomy. In Group A, only 15 patients with fissures were successfully treated (50%). By contrast, 28 (93%) patients with fissures in Group B were successfully treated, and only two (7%) remained uncured. These two patients (6.6%) in Group B suffered from incontinence due to flatus and feces as a complication of the procedure. Conclusion: This quasi-experimental study demonstrates that open partial lateral internal sphincterotomy is superior to topical 2% diltiazem application in the treatment of chronic anal fissure, with good symptomatic relief, high rate of healing, fewer side effects, and a very low rate of early continence disturbances.
Authors and Affiliations
Dr Manoj Kumar Gupta, Dr V. S. Prasad, Dr Anil Kumar, Dr Dejee Sinha
Keywords
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- DOI 10.9790/0853-1709101318.
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