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 A Comparison between the Results of Open versus Closed Lateral Internal Sphincterotomy in the Surgical Management of Chronic Anal Fissure

2018 ◽  
Vol 8 (3) ◽  
pp. 235-239
Author(s):  
Md Mahabub ◽  
Md Mahbubur Rahman ◽  
Md Tanvirul Islam ◽  
Selina Sultana
Keyword(s):  
Anal Fissure ◽  
Chronic Anal Fissure ◽  
Lateral Internal Sphincterotomy ◽  
Complication Rates ◽  
Open Technique ◽  
Female Ratio ◽  
Internal Sphincterotomy ◽  
Closed Technique ◽  
Increased Risk ◽  
Open Versus

Background: Lateral internal sphincterotomy is regarded as the gold standard surgical treatment for chronic anal fissure. Some authors reported that the closed technique had lower complication rates than that by the open technique, but others reported that both of the techniques had no meaningful differences in complications.Methods: This was a comparative and cohort study carried out at Department of Colorectal Surgery, Combined Military Hospital (CMH) Dhaka, Bangladesh, from October 2013 to October 2017. Eighty three patients with chronic anal fissure not responding to medical treatment for at least three months were included in this study to compare the results of the open versus closed techniques of lateral internal sphincterotomy after four months follow up postoperatively.Results: The mean age at presentation was 34.15±11.4 years and the male to female ratio was 1.24:1. The results of open and closed techniques were compared regarding per-operative bleeding (35.71% versus 12.19%), post-operative urinary retention (4.76% versus 0%), symptom relief on first post-operative day (76.19% versus 70.73%), significant 1st post-operative day pain in the operated wound (33.33% versus 7.31%), temporary fecal soiling (2.38% versus 0%), temporary flatus incontinence (7.14% versus 0%), and fissure recurrence (0% versus 14.63%) respectively. Temporary incontinence to fecal and flatus recovered by conservative management within two and four months of surgery respectively.Conclusion: The closed technique of lateral internal sphincterotomy had lower post-operative complications, pain, bleeding, and incontinence compared to open technique, but increased risk of fissure recurrence.Birdem Med J 2018; 8(3): 235-239

scholarly journals Treatment of Chronic Anal Fissure

2019 ◽  
Vol 19 (2) ◽  
pp. 67-71
Author(s):  
Abdullah Al Tarique ◽  
Md Manjur Alam
Keyword(s):  
Anal Fissure ◽  
Chronic Anal Fissure ◽  
Treatment Options ◽  
Dentate Line ◽  
Primary Treatment ◽  
Treatment Modalities ◽  
Healing Ulcer ◽  
Recurrence Rates ◽  
Support Device ◽  
Perineal Support

Chronic anal fissure is a non healing ulcer in the anoderm appearing as a painful tear below the dentate line. There are debates about the efficacy of different treatment options for chronic anal fissure. This review aims to evaluate existing and newer treatment modalities. Aspects of chronic anal fissure aetiology and pathogenesis are also reviewed. Glyceryl trinitrate (GTN) ointment, Diltiazem ointment can be used as first line and Botulinum toxin (BTX) injection as second line pharmacological treatment. The effects of these chemicals are not permanent with higher fissure recurrence rates. Lateral internal sphincterotomy is the operative treatment of choice for fissures with high anal tone. Flap anoplasty should be done for fissures with normal anal tone especially in female patients. Both surgical procedures can be used as primary treatment option. The newer treatment options like gonyautoxin, controlled balloon anal dilatation, closed anal spand fissurotomy need more research. Perineal support device can be used as an adjunct to other treatment modalities. Journal of Surgical Sciences (2015) Vol. 19 (2) : 67-71

scholarly journals High Rates of Recurrent Tuberculosis Disease: A Population-level Cohort Study

2020 ◽  
Author(s):  
Sabine M Hermans ◽  
Nesbert Zinyakatira ◽  
Judy Caldwell ◽  
Frank G J Cobelens ◽  
Andrew Boulle ◽  
...  
Keyword(s):  
Cape Town ◽  
Population Level ◽  
Fold Increase ◽  
First Episode ◽  
Individual Treatment ◽  
Risk Of Infection ◽  
Hiv Status ◽  
Recurrence Rates ◽  
Increased Risk ◽  
Subsequent Episode

Abstract Background Retreatment tuberculosis (TB) disease is common in high-prevalence settings. The risk of repeated episodes of recurrent TB is unknown. We calculated the rate of recurrent TB per subsequent episode by matching individual treatment episodes over a period of 13 years. Methods All recorded TB episodes in Cape Town between 2003 and 2016 were matched by probabilistic linkage of personal identifiers. Among individuals with a first episode notified in Cape Town and who completed their prior treatment successfully we estimated the recurrence rate stratified by subsequent episode and HIV status. We adjusted person-time to background mortality by age, sex, and HIV status. Results A total of 292 915 TB episodes among 263 848 individuals were included. The rate of recurrent TB was 16.4 per 1000 person-years (95% CI, 16.2–16.6), and increased per subsequent episode (8.4-fold increase, from 14.6 to 122.7 per 1000 from episode 2 to 6, respectively). These increases were similar stratified by HIV status. Rates among HIV positives were higher than among HIV negatives for episodes 2 and 3 (2- and 1.5-fold higher, respectively), and the same thereafter. Conclusions TB recurrence rates were high and increased per subsequent episode, independent of HIV status. This suggests that HIV infection is insufficient to explain the high burden of recurrence; it is more likely due to a high annual risk of infection combined with an increased risk of infection or progression to disease associated with a previous TB episode. The very high recurrence rates would justify increased TB surveillance of patients with >1 episode.

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 Is open lateral anal sphincterotomy really a safe and satisfactory treatment option for refractory chronic anal fissures? - a prospective study

2019 ◽  
Vol 7 (6) ◽  
pp. 2307
Author(s):  
Shabir Ahmad Mir ◽  
Zubair Gull Lone ◽  
Waseem Ahmad Dar ◽  
Mumtazdin Wani
Keyword(s):  
Prospective Study ◽  
Anal Fissure ◽  
Chronic Anal Fissure ◽  
Muslim Women ◽  
Chronic Stage ◽  
Anal Fissures ◽  
Medical College ◽  
Male Ratio ◽  
Female Predominance ◽  
A Prospective Study

Background: Chronic anal fissure is a familiar entity in surgical outdoor departments of hospitals in our valley. The muslim women are usually reluctant to expose their anal canal related pathologies to male surgeons, letting anal fissures to reach the chronic stage. Under this background, the present study was conducted to look for the feasibility of lateral anal sphincterotomy in the management of chronic anal fissure in our patients.Methods: This prospective study was carried out over a period of 3 years in the unit 2nd of department of surgery at SMHS (Shri Maharaja Harisingh) hospital, an associated hospital of Government Medical College Srinagar. During this period, 59 patients presented to the outpatient department with typical chronic anal fissures and were included in this study.Results: Fifty-nine patients, diagnosed on clinical evaluation as chronic anal fissure were included in this study. The age varied from 19 to 58 years with mean age of 36.38±7.14 (SD= 7.14) years. There was a female predominance, with a female to male ratio of 2.1:1. Fifty-two (88.1%) patients had posterior midline fissure and 7 (11.8%) patients had an anterior anal fissure. Thirty-one patients were not satisfied with the conservative treatment and insisted for surgical management. All 31 patients were managed by open lateral anal sphincterotomy.Conclusions: Lateral anal sphincterotomy (LAS) is a safe and effective method of management for chronic refractory anal fissures. The complications are minimal and negligible.

scholarly journals Topical diltiazem versus topical glyceryl trinitrate in the treatment of chronic anal fissure: a prospective comparative study

2019 ◽  
Vol 6 (4) ◽  
pp. 1127
Author(s):  
Venkatesh S. ◽  
Srinivas B. Kulkarni ◽  
Kruthi S. R.
Keyword(s):  
Glyceryl Trinitrate ◽  
Anal Fissure ◽  
Chronic Anal Fissure ◽  
Anal Verge ◽  
Complete Healing ◽  
P Value ◽  
Medical College ◽  
Chemical Sphincterotomy ◽  
Prospective Comparative Study ◽  
Topical Glyceryl Trinitrate

Background: Acute anal fissure (AAF) heals spontaneously with conservative line of treatment. Chronic anal fissure (CAF) needs either traditional surgical lateral sphicterotomy or chemical sphincterotomy with topical agents. The present study aims at the effectiveness of topical diltiazem (DTZ) cream over topical glyceryl trinitrate (GTN) ointment in the treatment of chronic anal fissure.Methods: A total of 100 patients with CAF were included in this comparative prospective study conducted in Rajarajeswari Medical College and Hospital Bengaluru from July 2017 to December 2018. Eligible patients were randomly assigned to one of the two treatment groups of 50 patients each and were advised to apply 2% DTZ cream or 0.2% GTN ointment by fingertip to the anal verge twice daily for 8 weeks. The results were analysed and compared on two weekly intervals to know the effectiveness of treatment. P value of <0.05 is considered to be significant.Results: Complete healing of the fissure occurred in 80% of the patients in DTZ group against 76% in the GTN group by the end of 6 weeks (p>0.05, statistically not significant). Mild headache was experienced by 14% of the patients in the DTZ group, while 46% of the cases in the GTN group reported about the same (p<0.05 statistically significant).Conclusions: Topical 2% DTZ appeared to be well tolerated and effective preferred first-line method of chemical sphincterotomy with less side effects for chronic anal fissure.

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