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
Related Articles
- EP ID EP395460
- DOI 10.9790/0853-1709101318.
- Views 88
- Downloads 0
Mini-Implants in Pediatric Dentistry
.
A comparative study of oral Nifedipine and intravenous labetalol in control of acute hypertension in severe pre-eclampsia and eclampsia.
Background: This study was conducted to compare oral Nifedipine and intravenous Labetalol in control of acute hypertension in severe pre-eclampsia and eclampsia. This study was observational study with 80 sample size in...
Prediction of changes in the arch dimensions after orthodontic treatment by a mathematical equation
Arch perimeter (AP), inter-canine width (ICW) and inter-molar width(IMW) are essential for diagnosis and treatment planning and are closely related factors in orthodontics. The aim of the present study was to determineth...
Value of Silver Binding Nucleolar Organiser Regions (AgNOR) in Squamous Cell Carcinomas of Upper Aero-digestive Tract
Background: Study of Silver-binding nucleolar organizing regions (AgNORs) in 100 cases of squamous cell carcinomas (SCC) of upper Aero-digestive tract was carried out with an aim of correlating AgNOR positivity with hist...
Intracranial Ependymomas in Children: The Role of Surgery And Adjuvant Treatment.
The management of pediatric intracranial meningiomas poses a big challenge. We are presenting the role of extent of tumor resection and adjuvant therapy in the survival of children with ependymomas. This is a retrospecti...