Comparative study of topical diltiazem sphincterotomy and lateral internal sphincterotomy in the treatment of chronic fissure-in-ano: a prospective analytical study
Journal Title: Scholars Journal of Applied Medical Sciences - Year 2016, Vol 4, Issue 4
Abstract
Abstract: Anal fissures are considered to be one of the commonest causes of proctalgia. Chronic fissure-in-ano is the condition when there is persistence of fissure for more than six weeks. Surgical techniques like manual anal dilatation or partial lateral internal sphincterotomy effectively heal most fissures, but may result in incontinence. Hence the search for alternative treatment options that includes pharmacological agents such as topical diltiazem, that doesn’t result in disabling incontinence. The objective was to study the efficacy of topical diltiazem sphincterotomy for chronic fissure-in-ano. To study the efficacy of Lateral internal sphincterotomy for chronic fissure-in-ano. To compare the efficacy of Topical Diltiazem sphincterotomy with Lateral internal sphincterotomy in terms of relief of symptoms, healing of fissure, and complications. The study includes 70 symptomatic Patients, suffering from Chronic Fissure-in-ano attending the Dept. of Surgery R.L.J. Hospital & RC and attached hospitals, Kolar, during the period from October 2012 to May 2014. These seventy patients were divided into Group-P (Pharmacologic Group/ Topical Diltiazem group) and Group-S (Surgical Group/ Lateral Sphincterotomy group) of 35 patients each by odd & even method. Patients are followed up at 2nd, 4th and 6th weeks for assessment of healing of fissure, pain relief and incontinence. Statistical analysis for P value is done by chi-square test. In Results In the present study, male/female ratio is 1.8:1; Peak incidence for development of fissure-in-ano was the fourth decade of life. Pain and bleeding during defecation were the commonest complaint. All patients complained of constipation. 98.6% of patients were consuming mixed diet. Relief of symptoms was 82.8% with group-p and 97.14% with group-s which was statistically significant with p value 0.04. Healing of fissure between the two group was statistically significant at 2 weeks, 4 weeks, and 6 weeks interval with p value <0.0001 at all three weeks. In Conclusion Lateral Internal Sphincterotomy is found to be better treatment modality for chronic Fissure-in-Ano than Topical Diltiazem ointment, in this study. It is associated with minimal post-op complications, like haemorrhage, impaired control of flatus and post op pain. However, Topical Diltiazem ointment can be used as the initial modality of treatment in patients unwilling or unfit for Lateral Internal Sphincterotomy. Keywords: Chronic fissure-in-ano; Lateral Internal Sphincterotomy; Topical Diltiazem Sphincterotomy
Authors and Affiliations
Anupam Choudhary, Pawan Katti, K. Krishna Prasad
Keywords
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