Volume : III, Issue : X, October - 2014

A STUDY ON DIFFERENT MODALITIES IN MANAGEMENT OF FISSURE IN ANO

Dr. Vishruth K. Raj, Dr. Mayur M. Kadam

Abstract :

ACKGROUND AND OBJECTIVES Fissure in Ano is defined as a longitudinal split in the anoderm of the distal anal canal, which extends from the anal verge proximally towards, but not beyond, the dentate line. It can be acute or chronic. Its situation in the unmentionable site adds to the morbidity as the shy and female patients avoid surgical consultation. Though fissure in ano is a very old entity, controversy still exists in the management of fissure in ano. An attempt is made in this dissertation to study the correlation between several etiological factors, morbidity, recurrences, and also comparatively study four modalities of treatment of fissure in ano.The purpose of this study is to: 1. To study the different clinical presentations and etiological factors of the fissure in ano. 2. To study the different modalities of treatment of fissure in ano i.e., application of Glyceryl trinitrate ointment, Sclerotherapy, Lord’s dilatation and Subcutaneous lateral internal sphincterotomy. 3. To study the complications associated with fissure in ano as well as those with its treatment. METHOD This is a prospective cohort study for a period of 15 months. 60 patients diagnosed to have fissure in ano were included in the study and divided into acute and chronic groups depending on the presentation. They were then treated with a predefined modality and efficacy and complications were studied. RESULTS Among 30 patients in the acute group 10 patients each were treated with sclerotherapy, application of GTN ointment and Lord’s dilatation. Sclerotherapy wasfound to have immediate pain relief in patients but very poor effect on healing of thefissure. Lord’s dilatation had good pain relief and fissure healing percentage but wasassociated with high rate of post treatment complications and disturbances of anal continence. GTN ointment was found to have good pain relief and fissure healing rateand also minimal post treatment complications. Among 30 patients in the chronic group 10 patients each were treated with GTN ointment application, Lord’s dilatation and Lateral internal sphincterotomy. GTN ointment was found to have good pain relief and fissure healing with headache being the only complication in a small percentage of patients. Lord’s dilatation again had a high rate of post op hemorrhage and post op disturbances in continence. Lateral internal sphincterotomy was by far the best method and had the best pain relief and fissure healing and the least complications. CONCLUSION This study showed that fissure in ano is the commonest painful condition of the anal canal and the maximum number of cases was encountered in the third decade of life. The male to female ratio was almost equal. The commonest presenting complaint in acute fissures was pain during defecation and in chronic fissures was a sentinel skin tag, while the second most common complaint in both was bleeding per rectum. The posterior midline was the commonest site of fissure in both males and females. Anterior fissures were rare and seen mostly in females. Application of GTN ointment was found to be the ideal treatment modality for acute fissure and lateral internal sphincterotomy the most ideal for chronic fissure. In patients with chronic fissure who refused or were unfit for surgery, GTN ointment application is the next best option.

Keywords :

Article: Download PDF   DOI : 10.36106/ijsr  

Cite This Article:

Dr. VISHRUTH K. RAJ,Dr. MAYUR M. KADAM A STUDY ON DIFFERENT MODALITIES IN MANAGEMENT OF FISSURE IN ANO International Journal of Scientific Research, Vol : 3, Issue : 10 October 2014

Number of Downloads : 2718

References :