Controlled digital anal dilatation under total neuromuscular blockade for chronic anal fissure: a justifiable procedure

1999 ◽  
Vol 86 (5) ◽  
pp. 651-655 ◽  
Author(s):  
N. A. Strugnell ◽  
S. G. Cooke ◽  
M. E. Lucarotti ◽  
W. H. Thomson
Keyword(s):  
Neuromuscular Blockade ◽  
Anal Fissure ◽  
Chronic Anal Fissure ◽  
Anal Dilatation

scholarly journals CHRONIC ANAL FISSURE

2011 ◽  
Vol 18 (02) ◽  
pp. 215-221
Author(s):  
MUHAMMAD ALI ◽  
TAHIR IQBAL MIRZA ◽  
RIAZ AKHTAR
Keyword(s):  
Anal Fissure ◽  
Surgical Procedures ◽  
Chronic Anal Fissure ◽  
Complete Healing ◽  
Military Hospital ◽  
Ulcer Recurrence ◽  
Anal Dilatation ◽  
Female Ratio ◽  
Comparison Results ◽  
Number Of Patients

Objective: To compare lateral anal sphincterotomy (closed method) with anal dilatation in the management of primary chronic anal fissure. Study design: A prospective, comparative, interventional study. Place and duration: Department of Surgery Combined Military Hospital Kohat from Jan 2001 to Mar 2002.Materials and Methods: During the period, all patients with primary type of chronic anal fissure, who were above 12 years of age and were fit for surgery, were selected for study. They were divided into two groups for both surgical procedures in a randomized manner. After their respective surgical procedures patients were followed up for four weeks on weekly basis. The changes in signs and symptoms were thoroughly reassessed and noted in a separate proforma maintained for each patient for the purpose of comparison. Results: The total number of patients was 49 with an average age of 40 years. Male to female ratio was 7:1. In 44 (89.79%) patients the fissure was located posteriorly while in 5 (10.20%) patients it was located anteriorly. Closed lateral anal sphincterotomy (LAS) was done in 28 (57.14%) patients, of which 25 (51.02%) were males and 3 (6.12%) females. While anal dilatation (AD) was done in 21 (42.85%) patients, 18 (36.73%) males and 3 (6.12%) females. In all the patients in whom LAS was done, there was disappearance of all the symptoms and complete healing of ulcer. Those operated by AD, there was disappearance of all the symptoms and complete healing of ulcer in only 8 (38%) patients. Incontinence was present in 9 (18.36%) patients. Three (14.2%) patients had persistence of ulcer while one (4.76%) was having recurrence of ulcer.Conclusion: Lateral anal sphincterotomy, especially close method gives excellent results as compared to anal dilatation in terms of ulcer healing, disappearance of symptoms and lower rate of ulcer recurrence or incontinence. 

scholarly journals Comparative study of manual anal dilatation and lateral internal anal sphincterotomy in the treatment of acute anal fissure

2019 ◽  
Vol 6 (6) ◽  
pp. 2022
Author(s):  
Hareesh G. S. R. ◽  
Padmanabham Somangurthy
Keyword(s):  
Anal Fissure ◽  
Chronic Anal Fissure ◽  
Risk Of Infection ◽  
Anal Dilatation ◽  
Inclusion Criteria ◽  
Recurrence Rates ◽  
Painful Condition ◽  
Medical College ◽  
Post Operative Pain ◽  
Increased Risk

Background: An anal fissure is an extremely common condition which is also one of the most painful condition. It can be very troubling because, if acute, the severity of patient discomfort and extent of disability far exceed that which would be expected from a seemingly trivial lesion. This study compares two most commonly done procedures for anal fissure, manual anal dilatation (MAD) and lateral internal anal sphincterotomy (LAS).Methods: This is a prospective cohort study comparing MAD and LAS in the treatment of chronic anal fissure at Sri Venkateswara Medical College, Tirupati, from December 2017 to December 2018. A total of 60 patients who met inclusion criteria were randomized to undergo either MAD or LAS and analyzed for post-operative pain, post-operative complications, hospital stay, recurrence rates and compliance.Results: Total 60 patients were randomized to MAD and LAS. The patients who have undergone LAS have better pain relief and slightly increased risk of infection. Those who have undergone MAD have less risk of infection and recurrence rates and complications are not significantly less than LAS.Conclusions:MAD and LAS are both equally effective and safe for treatment of acute anal fissure with less chances of recurrence. However postoperative pain was slightly more in MAD group. 

scholarly journals Treatment of Chronic Anal Fissure -Anal Dilatation-

2011 ◽  
Vol 64 (10) ◽  
pp. 883-886
Author(s):  
Ken Tarumi ◽  
Yuji Ishiyama ◽  
Maiko Kawamura ◽  
Gentaro Ishiyama ◽  
Akihiko Nishio
Keyword(s):  
Anal Fissure ◽  
Chronic Anal Fissure ◽  
Anal Dilatation

scholarly journals A prospective, randomize study of comparison of lateral internal sphincterotomy versus Lord’s anal dilatation in chronic anal fissure

2018 ◽  
Vol 5 (3) ◽  
pp. 1026
Author(s):  
Dhiraj Kumar ◽  
Anil Negi ◽  
Neeraj Kumar ◽  
Avinash Pandey
Keyword(s):  
Anal Fissure ◽  
Chronic Anal Fissure ◽  
Tertiary Care ◽  
Surgical Techniques ◽  
Recurrence Risk ◽  
Lateral Internal Sphincterotomy ◽  
Care Hospital ◽  
Anal Dilatation ◽  
Female Ratio ◽  
Internal Sphincterotomy

Background: Surgical techniques for management of chronic anal fissure are Lords anal dilatation (LAD) and Lateral internal sphincterotomy (LIS). The aim of this study is to compare the symptoms, post-operative complications and recurrence risk of the above two techniques.Methods: It was a prospective, randomized controlled trial done in department of General Surgery of a tertiary care hospital from June 2016-May 2017. A total of 100 patients lined up for surgical management of CAF were divided into two groups (50 each). In group A, 50 patients underwent LAD and in group B, 50 underwent LIS. Patients were followed up for 6 months following surgery for pain, bleeding, incontinence, post-operative hospital stay and recurrence. Wong Baker scale, Modified Longo score and Wexner scales were used for assessment of pain, constipation and incontinence respectively. Various post-operative symptoms, complications and recurrence risk were evaluated post operatively at 24 hours, before discharge from the hospital, 1st, 3rd and 6th months of operation respectively.Results: Male female ratio was 1.7:1. Most common presenting complaint was pain seen in 96% patients. Sentinel tag at 6 o’clock position was seen in the majority (93%) patients on presentation. Except for pain score, which was statistically more significant at 24 hours postoperatively in the LAD group (p=0.012), there was no statistical difference between the two groups when compared at different points of evaluation for symptoms, complications and recurrence (p=0.565).Conclusions: With minor difference in pain, Lord’s dilatation has similar post-operative symptoms; complications and recurrence risk when compared with lateral internal sphincterotomy procedure, for management of CAF and can be safely performed.

scholarly journals Efficacy of Diltiazem 2% Cream as a Solid Treatment of Patients with Chronic Anal Fissure at Kirkuk General Hospital

2020 ◽  
Vol 3 (2) ◽  
pp. 97-107
Author(s):  
Ali Galleb ◽  
Hazim Ahmed
Keyword(s):  
General Hospital ◽  
Anal Fissure ◽  
Chronic Anal Fissure ◽  
Complete Recovery ◽  
Second Line ◽  
Anal Dilatation ◽  
First Line ◽  
First Line Therapy ◽  
Line Therapy ◽  
Surgical Operations

Background: Chronic anal fissure is a common painful benign anorectal case. Surgical operations like lateral internal sphincterotomy or manual anal dilatation are effective for healing most cases within a few weeks. However, as a side effect, permanent impaired anal.continence is likely to occur Aim: This article aims to evaluate whether the pharmacological can be the first-line option for.the treatment of chronic anal fissure Patients and Methods: 60 patients are enrolled with a chronic anal fissure in this work. The cases were chosen randomly from Kirkuk general hospital during the period from February 2017 to October 2018. As a first-line therapy, all patients treated with diltiazem 2% cream for.6 weeks Results: As a result of adverse drug reaction and uncooperative patients, 10 patients were unable to complete medical treatment, while 50 patients were able to complete it. Furthermore, 40 patients (out of 50) achieved complete recovery with 25 males and 15 females. Nevertheless, 10 patients (7 males and 3 females) were failed to reach complete recovery, which makes undergoing sphincterotomy as a second-line option. Complete recovery is achieved in (n=45) 90% of patients within 5-6 weeks from the start of diltiazem 2% cream. Whereas, 10% of them (n=5) recovered with complete 6 weeks administration of .the cream Conclusions: For majority patients with a chronic anal fissure, diltiazem 2% cream with a course of six weeks was the first-line choice therapy

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