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

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

Manual anal dilatation for the treatment of chronic anal fissures: our experience

Background: In this study we aim to present our experience in managing chronic anal fissures by manual anal dilatation in order to clarify whether this method is still viable in a modern surgical setup.Methods: A total of 55 patients who underwent manual anal dilatation for chronic anal fissures from March 2016 till March 2017 were studied prospectively.Results: 43 of the 55 patients were male and 12 were female (male: female=3.58: 1), aged between 20 to 60 years. The fissure was posterior at 6 o'clock position in 44 patients (80%) and anterior at 12 o'clock position in 8 patients (14.5%). Mean duration of hospital stay was 1.5 days. At the end of 6 weeks post op, only 37 patients (67.3%) were symptom free with the remaining 18 patients (32.7%) having complications. Among the complications, the commonest was ulcer persistence in 12 patients (21.8%). 3 patients had incontinence for flatus (5.5%), 2 had recurrence of ulcer (3.6%) and 1 had incontinence for faeces (1.8%). Mortality was 0%.Conclusions: Anal fissure is a common benign ano-rectal condition. Once chronicity is established, it is difficult to treat and almost always warrants surgical management. Although manual anal dilatation is a simple and easy procedure, it is associated with significant rates of complication. For long term definitive treatment, manual anal dilatation should be abandoned completely in favour of other surgical techniques like lateral subcutaneous sphincterotomy.

Graded therapeutic approach to fissure in ano: study of 50 cases

Background: Fissure in ano is one of the commonest disease affecting all age groups. The condition is quite painful leading to interference in activities of daily living. A wide variety of modalities ranging from medical to surgical approaches have been proposed. However no single modality can be called the gold standard of treatment. Hence the need to develop an optimum graded approach to manage the condition.Methods: Fifty consecutive cases of fissure in ano presenting in an acute state were studied prospectively to develop a therapeutic algorithm for rational treatment of the painful condition.Results: Conservative treatment was commenced in all cases. Eighteen required anal dilatation while out of these eighteen patients, ten required sphincterotomy despite anal dilatation. Four patients had recurrence of symptoms despite all surgical treatments.Conclusions: Conservative treatment still has a significant and positive outcome in fissure in ano. Anal dilatation and sphincterotomy are the next options of treatment. Therefore a graded multimodal approach is therapeutic in treating fissure in ano.

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

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.

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

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.