Comparison of Glyceryl Trinitrate Ointment versus Internal Lateral Sphincterotomy for Anal Fissure Pain Relief

Background: Anal fissure is a linear painful mucosal tearing in the distal part of anal canal. It extends from dentate to anal edge. Aim: To compare the glyceryltrinitrate ointment and internal lateral sphincterotomy for anal fissure pain relief in acute/chronic pts. Study Design: Prospective study Place and duration of study: Department of Surgery Unit-II, Fatima Memorial Hospital, Shadman Lahore from 1st October 2018 to 31stDecember 2020. Methodology: 40 pts with acute and chronic anal fissure were enrolled. Half of the patients undergo internal lateral sphincterotomy while other opted 0.2% use of glyceryl trinitrate ointment. Each patient was followed for pain, recovery, complications and recurrence until 12 months for internal lateral sphincterotomy and 18 months in glyceryl trinitrate ointment. Results: There were 24 males and 16 females with a mean age of patients as 30±3.2 years. Initial follow-up of patients showed 100% pain and fissure improvement in internal lateral sphincterotomy group as compared to 60% in glyceryl trinitrate ointment group respectively. Conclusion: Internal lateral sphincterotomy is most efficient and reliable procedure in relieving anal fissure pains. Keywords: Anal fissure, Internal lateral sphincterotomy, Glyceryl trinitrate

A COMPARATIVE STUDY OF 0.2% NIFEDIPINE VERSUS LATERAL SPHINCTEROTOMY IN THE MANAGEMENT OF ANAL FISSURE

Introduction:Anal ssures are longitudinal tears in the squamous epithelium of the anal canal. Anal ssures are located distal to the dentate line, and in around 90% of cases they are located on the posterior midline. The most common pathologies of the anorectal region and can change the quality of life as it causes patient pain and emotional stress while defecation. With a lifetime risk of 11%, anal ssure is a common problem in routine medical care. Anal ssure is mainly treated by relaxing the spasm of the internal sphincter either by dilating the anal canal or sphincterotomy. Reduction of spasticity of anal sphincters is the special treatment for ssure healing. For this purpose, the treatment of anal ssures is performed by lateral sphincterotomy or by anal dilatation. Methods: Out of 100 randomly selected 50 patients with inclusion and exclusion criteria and informed consent were treated with nifedipine ointment and 50 patients with informed consent were treated with lateral sphincterotomy for management of anal ssure. Observations after treatment were recorded at second week, sixth week and twelfth week interval for bleeding, pain and healing and at the twelfth week follow up was documented to analyse the result of treatment. Result: Out of 50 patients undergoing treatment with Nifedipine ointment 42 patients healed completely. 36 patients in the nifedipine group had complaint of bleeding, after treatment with nifedipine ointment 30 patients were relieved from bleeding while 6 were complaining of bleeding on follow up after 3 months. Patients in lateral sphincterotomy group underwent surgery under spinal anaesthesia. In lateral sphincterotomy group, ssure healing was found in 49 (98%)out of 50 patients. In our study out of 50 patients, 48 (96%)were completely relieved from pain and 2 ( 4% ) had pain on follow up at the end of 3 months. In our study , in the lateral sphincterotomy group 34 patients out of 50 patients were complaining of bleeding and after surgery 32 were relieved from bleeding within 12 weeks and 2 were complaining of bleeding. Conclusion:Topical 2% nifedipine should be given as the rst option of treatment for anal ssure. Lateral sphincterotomy, which gives better result to relieve the symptoms but require hospitalization, should be offered to patient who present with relapse and does not respond to pharmacological treatment.

Transient bladder incontinence following ultrasound guided caudal epidural block

Caudal anesthesia is commonly used a regional anesthesia technique for sub-umbilical surgeries in pediatrics and for chronic pain management in adults. Ultrasound guided caudal epidural block improves the success rate with minimizes complications. We report a patient who underwent lateral sphincterotomy under ultrasound guided caudal epidural anesthesia and developed transient urinary incontinence with prolonged perineal sensory loss postoperatively. Key words: Anesthesia, Caudal epidural, Ultrasound. Citation: Preethipriyadharshini R, Vadhanan CP, Bokka N. Transient bladder incontinence following ultrasound guided caudal epidural block. Anaesth. pain intensive care 2021;25(1):102–104; DOI: 10.35975/apic.v25i1.1437 Received: 17 October 2020; Reviewed: 4 November 2020; Accepted: 5 December 2020

A PROSPECTIVE STUDY OF OPEN VERSUS CLOSED LATERAL INTERNAL SPHINCTEROTOMY IN CHRONIC ANAL FISSURES

Background: Fissure-in-ano is a very common anal disorder which predominantly presents with severe pain. Lateral internal sphincterotomy remains the main treatment modality. This may be performed using open or closed method, each with their attendant complications. Objective: This prospective study compared the results and complications of open versus closed technique of lateral sphincterotomy in patients with chronic anal ssure. Materials and Methods:Atotal of 64 patients with chronic anal ssure were enrolled in this study. Of these, 34 patients underwent open lateral sphincterotomy, and 30 underwent closed sphincterotomy. They were followed up for 6 months postsurgery. The results and complications of the two groups were compared and statistically analyzed. Results: Post-operative complications such as pain, bleeding, infection, incontinence, and recurrence were compared between the two groups. Pain, bleeding, and incontinence to atus were signicantly lesser in the closed group (P < 0.05), while there was no difference in the incidence of infection and recurrence between the two groups. Conclusion: Closed lateral internal sphincterotomy is a better alternative compared to open sphincterotomy in the treatment of chronic anal ssures.

Comparision of Postoperative Complications Associated with Closed Lateral Sphincterotomy and Fissurectomy with Dorsal Sphincterotomy in Chronic Anal Fissure

Background: Chronic anal fissure is clinical entity associated with significant pain and discomfort with bleeding. Different surgical options are being used nowadays to treat the ailment. Closed lateral sphincterotomy is being considered as gold standard treatment however, dorsal sphincterotomy with removal of chronic fissure is also used as treatment. Objectives: To compare effectiveness and patient satisfactions after both surgical procedures. To identify the common complications associated both surgical procedures. Methodology: The cross sectional conducted at Ghulam Muhammad Maher Medical College Sukkur from January 2016 to December 2019. Total 300 male patients with history of Chronic Anal Fissure for more than 6 months were included in the study. The patients were divided into two groups Group-A (150 patients) underwent lateral sphinterotomy whereas in Group-B (150 Patients) dorsal sphincterotomy with fissurectomy was performed. Randomization for grouping was performed by single blind sealed envelope technique. Patients with additional anorectal disease, haemorrhoids, HIV, HBV, HCV, and female patients were excluded from study. After performing surgery in both the groups follow-up was performed for 2 years and data was analyzed. Results: Mean age was 30.5 4±12.3 years, most common site of fissure among our study population was 6 O’ Clock (p-value=0.003), pain was seemed to be significant post-operative completion in both the groups however, both the treatment strategies appeared to be equally effective though patients in group B were more satisfied than group A. Conclusion: Both methods of surgeries seemed to be equally effective in treating the ailment. Recurrence after both surgeries was uncommon though pain was common postoperative complication.

Single centre randomized comparative trial of lateral internal sphincterotomy versus 2% diltiazem in chronic anal fissure

Background: Anal fissures are often encountered in surgical practice with surgery the gold standard management for chronic anal fissures. Recently the widespread use of pharmacologic agents for chronic fissures has increased. In our study we compare topical 2% diltiazem with lateral sphincterotomy with respect to symptoms such as relief of pain, ulcer healing, and side effects of treatments.Methods: A prospective comparative study, a total of 80 patients were randomized into 2 groups 40 each. Group A patients were subjected to open internal lateral sphincterotomy and group B to 2% topical diltiazem. The patients in both groups were followed up at 1st, 4th, 14th weeks and 6 months in OPD and were assessed for pain, sphincter tone and complications.Results: In group A (lateral anal sphincterotomy), patients achieved a good pain relief with a mean pain score of 1.98 by one week post procedure whereas group B (2% diltiazem) had taken 14 weeks to achieve similar pain relief (pain score of 1.5). At the end of 6 months, healing of fissure was noted in 100% of group A and in 90% of group B. 4 patients (10%) had recurrences in group B. Flatus incontinence was reported in 2 patients (5%) in group A although transient.Conclusions: Lateral anal sphincterotomy is superior to 2% diltiazem especially in healing of fissure, pain relief, quality of life and recurrence. Pharmacologic agents should be reserved for patients who are unfit or unwilling for surgery or can be used as a bridge therapy till sphincterotomy can be planned.