A comparative study of Glyceryl Trinitrate versus surgical management of chronicanal fissure

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A comparative study of Glyceryl Trinitrate versus surgical management of chronicanal fissure

Journal Title: Medpulse International Journal of Surgery - Year 2017, Vol 3, Issue 3

Abstract

Background: Anal fissure is an elongated ulcer in the long axis of lower anal canal causing significant morbidity due to sharp severe anal pain, especially during defecation. Young adults are the usual sufferers. Aims and Objectives: To Study effectiveness of Glyceryl Trinitrate Versus Surgical Management of Chronic Anal Fissure. Methodology: This prospective study, included a total of 40 patients presented with chronic anal fissure divided into two groups by computer generated randomization. Group A included 20 patients with chronic anal fissure treated with local glyceryltrinitrate ointment 0.2% (liposomal base) applied twice daily for 6 weeks. Group B included 20 patients managed by lateral internal sphincterotomy. All patients were treated by the same surgeon using a uniform method in the lithotomy position with the same technique of sphincterotomy. Patient who given written consent were included into study while those who didn’t given consent, were immune compromised, terminally ill were excluded from the study. Statistical analysis done by unpaired –t calculated by Graph Pad Prism -6 software. Result: Procedure time was significantly lower in Group A compared to Group B(P< 0.0001 ;t = 10.00; df=38.); Procedure bleeding was significantly lower in Group A compared to Group B (P< 0.0001 ; t = 41.1437 df=38); Time to first bowel movement (hr) was significantly lower in Group A compared to Group B (P<0.0001; t = 14.10;df=38); Average hospital stay (Days) was significantly lower in Group A compared to Group B (P<0.0001; t = 4.00 ; df=38); Average Analgesic required (No. of Tab.) was significantly lower in Group A compared to Group B (P<0.0001;t=15.81; df=38). Time required for Wound healing was significantly lower in Group A compared to Group B (P<0.0001;t=10.73;df=38) Overall the complications were, more in the Group B (35%) as compared to Group A (10%). The complications like Urinary retention, Bleeding, Incontinence of flatus, Recurrence, Anal stenosis, were common in Group B than Group A. Conclusion: Overall the outcomes like less Procedural bleeding, less time for the first bowel movement with less analgesic were better in Glyceryl Trinitrate treatment group and overall complications were less in Glyceryl Trinitrate treatment group compared to conventional surgical sphincterotomy group.

Authors and Affiliations

Milind Ramdas Patil, Hemant Sharad Kelkar

Keywords

Glyceryl Trinitrate Anal Fissure lateral internal sphincterotomy.

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EP ID EP481909
DOI 10.26611/1063315
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