RETROSPECTIVE ANALYSIS OF LSIS VERSUS PHARMACOLOGICAL MANAGEMENT IN ACUTE ANAL FISSURE- A STUDY IN ZONAL SERVICE HOSPITAL
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2018, Vol 7, Issue 41
Abstract
BACKGROUND Acute anal fissure is a quite common and extremely painful condition of anal canal. The prevalence of anal fissures has changed due to change in food habits in the Indian subcontinent. Medical management is a recent trend in the treatment of anal fissure; however, the parameters for measurement of outcome are result-based and not measuring quality of life post treatment. Here, we have conducted a retrospective study of our patients, which were managed by various medical methods and lateral subcutaneous internal sphincterotomy. The results of the study were documented and studied retrospectively. The results were analysed on various parameters of symptomatic relief of pain, after different periods of time and improved comfort during and after treatment. The incidence of anal fissure in males and females were also studied. Recent studies and clinical work are advocating medical management of acute anal fissure citing reasons of early recovery and avoiding unnecessary admissions. However, it seems a very short-sighted development, because either the cases which had recurrence may not have reported back or it may be short term solution without considering long-term implications. The aim of the study was to evaluate role of Lateral Subcutaneous Internal Anal Sphincterotomy (LSIAS) vis-a-vis conservative management in cases of acute anal fissure in terms of clinical parameters. MATERIALS AND METHODS It is a descriptive study of results of patients in a service-hospital surgical-OPD and in-patient cases. Patients were administered treatment and results were analysed at the time of discharge. Data of only those patients were used who could be followed up for next 6 months. RESULTS In our clinical study, it was found that surgical intervention in the initial and first encounter has better overall response as compared to conservative management over a period of time. CONCLUSION With this study it can be safely concluded that in an acute anal fissure, surgical intervention in the first setting has maximum chances of early recovery, reduced loss of man hours, comparatively better post-treatment period and importantly reduced chances of progress to chronic anal fissure. It does not absolutely rule out the role of conservative management by using GTN and CCBs in addition to the traditional conservative supportive management; however, it needs strict compliance with the treatment protocol, sudden change in dietary preferences and a cooperative patient. It is also understood that pain and sense of constant discomfort in anal canal is more disturbing and an important parameter than others while considering response to treatment outcome.
Authors and Affiliations
Bharat K. Jani, Hemant S. Nagar
Keywords
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- EP ID EP548394
- DOI 10.14260/jemds/2018/997
- Views 88
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