scholarly journals CHRONIC ANAL FISSURES

2007 ◽  
Vol 14 (02) ◽  
pp. 318-322
Author(s):  
TARIQ WAHAB KHANZADA ◽  
ABDUL SAMAD
Keyword(s):  
Pain Relief ◽  
Glyceryl Trinitrate ◽  
Initial Treatment ◽  
Selection Criteria ◽  
Chronic Anal Fissure ◽  
Complete Healing ◽  
University Hospital ◽  
Internal Sphincterotomy ◽  
Topical Glyceryl Trinitrate ◽  
One Year

Objective: The objective of this study was to compare the topical GTN andlateral internal sphincterotomy for the treatment of chronic anal fissure. Setting: This was a prospective randomizedcohort study conducted at Isra University Hospital, Hyderabad between September 2004 and August 2005. Materialand Methods: Fifty patients fulfilling the selection criteria were randomly divided into two equal groups. One group wastreated with topical glyceryl trinitrate (GTN) ointment and other group was treated with lateral internal sphincterotomy.Patients were followed up in outpatients department after regular intervals for about one year. The data was collectedand two groups were compared with special reference to pain relief, fissure healing and recurrence rate. Results: Painrelief was observed in 96% of the patients in GTN group as compared to 92% of the patients in sphincterotomy groupafter 6 weeks. Complete healing of fissure was observed in 92% of the patients in GTN group as compared to 88% ofthe patients in sphincterotomy group after 6 weeks. Recurrence was observed in 16% of the patients in GTN group ascompared to 4% of the patients in sphincterotomy group after one year. Conclusion: GTN and lateral internalsphincterotomy are comparable in terms of pain relief and fissure healing after 6 weeks. Topical GTN is suggested tobe the initial treatment whereas lateral internal sphincterotomy is suggested to be reserved for the patients notresponding to topical GTN or having recurrence after completion of treatment with GTN.

scholarly journals Comparative evaluation of fissurectomy versus lateral internal sphincterotomy in the treatment of chronic anal fissure

2018 ◽  
Vol 5 (4) ◽  
pp. 1407
Author(s):  
A. R. Bansal ◽  
Pradeep Yadav ◽  
Suvendu Jena ◽  
Sanjeev Kumar
Keyword(s):  
Side Effects ◽  
Pain Relief ◽  
Anal Fissure ◽  
Comparative Evaluation ◽  
Chronic Anal Fissure ◽  
Symptomatic Relief ◽  
Age Groups ◽  
Complete Healing ◽  
Lateral Internal Sphincterotomy ◽  
Internal Sphincterotomy

Background: Anal fissure is a common anorectal condition that affecting all age groups, but it is seen in young and healthy adults with equal incidence across both the sexes. The objective of this study was to evaluate and prospectively compare fissurectomy versus lateral internal sphincterotomy in the treatment of chronic anal fissure in terms of symptomatic relief, healing, recurrence and incontinence, if any.Methods: 50 patients with chronic anal fissure were alternately divided in two groups. In one group fissurectomy was done and in another group, patients underwent lateral internal sphincterotomy and comparative evaluation was done.Results: Complete healing was observed in 92% patients in fissurectomy group and 96% patients in lateral internal sphincterotomy group at the end of 6 weeks. Fissurectomy group patients reported early cut through of sutures and infection whereas in lateral internal sphincterotomy group two patients developed perianal hematoma at 3 months of follow up.Conclusions: While considering surgical management for treating chronic anal fissure, fissurectomy is comparable to lateral internal sphincterotomy in terms of symptomatic pain relief, healing rates with minimal side effects and low recurrence.

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.

scholarly journals Comparative study of Glyceryl Trinitrate ointment versus lateral internal sphincterotomy in management of Chronic anal fissure.

2019 ◽  
Vol 26 (12) ◽  
pp. 2241-2245
Author(s):  
Waqas Hussain Qureshi ◽  
Zahid Sattar ◽  
Akhtar Mahboob ◽  
Aakif Yousaf ◽  
Sajid Mukhtar ◽  
...  
Keyword(s):  
Pain Relief ◽  
Glyceryl Trinitrate ◽  
Anal Fissure ◽  
Chronic Anal Fissure ◽  
Lateral Internal Sphincterotomy ◽  
P Value ◽  
Internal Sphincterotomy ◽  
Randomized Control ◽  
Glyceryl Trinitrate Ointment ◽  
Trial Setting

Objectives: To compare efficacy of topical 0.2% glyceryl trinitrate ointment with lateral internal sphincterotomy in treatment of patients with chronic anal fissure. Study Design: Randomized Control Trial. Setting: Department of General Surgery, DHQ Teaching Hospital, Sahiwal. Period: From 20 September 2016 to 31 December 2017. Material & Methods: A total number of 60 patients included in this study and divided into two groups GTN and LIS group through computer generated randomization method. Three main outcome variables were assessed in this study; pain relief, healing of fissure and recurrence. SPSS version was used to analyze data. P value ≤ 0.05 was considered as significant. Results: A total number of 60 patients included in this study. Relief of pain GTN and LIS was (95%) and (86.7%) respectively. Fissure healing GTN and LIS was noted as (88.3%) and (83.3%) respectively. Recurrence was not found in any patient of the present study. Relief of pain was statistically significant. Conclusion: Topical application of GTN ointment for relief of pain is safe and effective method for relief of chronic anal fissure but pain relief is slow. On other hand lateral internal sphincterotomy is first line treatment and treatment of choice for chronic anal fissure when performed by an experienced surgeon.

scholarly journals Topical Diltiazem Versus Topical Glyceryl Trinitrate In The Management Of Chronic Anal Fissure

JMS SKIMS ◽  
2014 ◽  
Vol 17 (2) ◽  
pp. 55-58
Author(s):  
Shams Ul Bari ◽  
Ajaz Ahmad Malik ◽  
Khurshid Alam Wani ◽  
Ajaz A Rather
Keyword(s):  
Side Effects ◽  
Anal Fissure ◽  
Chronic Anal Fissure ◽  
P Value ◽  
Double Blind ◽  
Surgical Methods ◽  
Significant Difference ◽  
Topical Glyceryl Trinitrate ◽  
One Year

Background: Chemical sphincterotomy is a novel way for treating patients of chronic anal fissure which avoids the risk of fecal incontinence associated with traditional surgical methods. Aims and objectives: The aim of this study was to compare the results of topical Diltiazem with topical Glyceril trinitrate in the management of chronic anal fissure. Methods: 71 patients in the age group of 15 - 61 years with chronic anal fissure were included in this prospective, randomized, double-blind trial over a period of two years with further follow up for one year. The patients were randomly allocated to either Diltiazem gel 2% (37 patients) or Glyceril trinitrate ointment 0.2% (34 patients) and were asked to use the treatment twice daily for 8 weeks. Each patient was reviewed every two weeks. Symptoms, healing, side effects and recurrence were compared using SPSS version 10 employing X2 test. A p-value below 0.05 was considered statistically significant. Results: Patients who received topical diltiazem (DTZ) showed statistically significant difference than those who were prescribed topical glyceril trinitrate in terms of symptoms, wound healing, side effects ( headaches) and recurrence (p=0.03 and 0.003 respectively). Healing occurred in 34 of 37 (92%) patients treated with Diltiazem after 6 weeks and 27 of 34 (80%) patients treated with Glyceril trinitrate after 8 weeks, which shows a significant difference in favour of Diltiazem (P < 0.001). The rest of the patients did not heal and underwent sphincterotomy (SILS). Headache occurred in all of the patients treated with Glyceril trinitrate but none of the patients treated with Diltiazem. Conclusion: Diltiazem gel was found to be better than Glyceril trinitrate ointment due to significantly higher healing rate and fewer side-effects. JMS 2014;17(2):55-58

scholarly journals Evaluation of clinical effectiveness of topical 0.2% glyceryl trinitrate, topical 2% diltiazem and their combination in the treatment of chronic anal fissure

2020 ◽  
Vol 8 (3) ◽  
pp. 156-161
Author(s):  
Bikash Bahadur Rayamajhi ◽  
Anjan Khadka ◽  
Kabir Thakali ◽  
Bikash Bikram Thapa ◽  
Narayan Thapa ◽  
...  
Keyword(s):  
Glyceryl Trinitrate ◽  
Anal Fissure ◽  
Chronic Anal Fissure ◽  
Visual Analog Scale Score ◽  
Clinical Effectiveness ◽  
Dentate Line ◽  
Initial Therapy ◽  
Complete Healing ◽  
Channel Blockers ◽  
Chemical Sphincterotomy

Background: The longitudinal tear or defect in the epithelial lining of the anal canal distal to the dentate line is called anal fissure. It is of two types: acute and chronic. The break in the cycle of pain, spasm and ischemia is essential for successful treatment of anal fissure. Among multiple non-surgical treatment approaches, the appropriate approach with good patient compliance might be the use of topical agents as chemical sphincterotomy. However, the effectiveness of these agents has not been evaluated widely. Objectives: To evaluate clinical effectiveness of topical 0.2% glyceryl trinitrate, topical 2% diltiazem and their combination in the treatment of chronic anal fissure. Methodology: The study was prospective comparative type including total 158 patients. Initially, they were given first line therapy followed by chemical sphincterotomy agents. The study drugs were given to 84 patients (three groups - 0.2% glyceryl trinitrate, 2% diltiazem and their combination) who were not healed after initial therapy. Patients were assessed for pain using visual analogue scale and other symptoms prior to and after two and six weeks of therapy. Results: Complete healing rate was higher with combination (92.86%) than individual agents. The reduction of visual analog scale score within each group and between the groups in the period between before and after treatment was found to be statistically significant. Headache and hypotension were the common side effects seen during study. Conclusion: Anal fissures can be successfully managed by chemical sphincterotomy. The topical nitrates and calcium channel blockers in combination are found to be effective choice rather than individual agents.

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