SURGICAL VS MEDICAL MANAGEMENT OF ANAL FISSURE: A COMPARITIVE STUDY

DR PRATEEK SHAKYA; DR SHRIRANJAN KALA; DR PANKAJ KUMAR VERMA

Volume : VII, Issue : XI, November - 2018

SURGICAL VS MEDICAL MANAGEMENT OF ANAL FISSURE: A COMPARITIVE STUDY

Dr Prateek Shakya, Dr Shriranjan Kala, Dr Pankaj Kumar Verma

Abstract :

Anal fissure is a very common surgical problem presented with severe pain during defecation along with bleeding per anum and constipation. The aim of study is to compare the management and outcome between lateral sphincterotomy and diltiazem application in anal fissures at Sushila Tiwari Hospital.

Methods : We included 100 patients of diagnosed anal fissure of age group 20 to 80 yrs who were randomized blindly into two group : Group 1 (Surgical ) vs. Group 2 (Medical).Group 1 undergone lateral sphincterotomy while Group 2 were advice application of 2% Diltiazem gel three times a day into the anus for 6 consecutive weeks. Both groups were followed up at 2 week, 4 weeks, and 6 weeks, after the treatment.

Result: Among all the 100 patients, all patients had come with complaint of pain whereas 75 patients had bleeding per rectum and 42 had constipation. On clinical examination, 90 patients had posterior anal fissure. Each group had 50 patients. Comparison between internal sphincterotomy and Diltiazem gel therapy showed a difference in pain relief (P<0.00001) and fissure healing (P= 0.00001) which is statistically significant. But there was no significance regarding bleeding (p=0.68) as both are showing similar results.

Conclusion: This prospective study, demonstrates that open lateral internal sphincterotomy is superior to topical Diltiazem application in the treatment of anal fissure with good symptomatic pain relief, high rate of healing.