COMPARISON OF LATERAL INTERNAL PARTIAL SPHINCTEROTOMY AND TOPICAL USE OF GLYCERYLTRINITRATE OINTMENT (0.2%) IN THE MANAGEMENT OF CHRONIC ANAL FISSURE
DOI:
https://doi.org/10.52206/jsmc.2014.4.2.487-491Abstract
OBJECTIVE: The objective of this study was to compare the results of surgical internal
sphincterotomy with that of local 0.2% Glyceryltrinitrate ointment (chemical, sphincterotomy) in the
treatment of chronic anal fissure.
STUDY DESIGN: This is a descriptive, comparative, prospective study.
PLACE AND DURATION OF STUDY: The study was conducted in the Department Of Surgery
Saidu Group of Teaching Hospital Saidu Sharif Swat from January 2011 to January 2014.
PATIENTS AND METHODS: Total of one hundred and fortypatients between the age of 15 and 60
years with chronic anal fissure were randomized in a prospective trial to receive either surgical
sphincterotomy or 0.2% Glyceryl trinitrate ointment locally. Patients were followed up at 2 weeks’
interval for 14 weeks. Symptomatic relief, fissure healing and anal continence were the parameter for
the outcomes. Data was analyzed using SPSS version 16 employing chi-square test(X test). A p-value
below 0.05 was considered statistically significant.
RESULTS: Surgical sphincterotomy was significantly more effective in providing pain relief and was
associated with significantly better fissure healing at 6 weeks and 10 weeks, in all 66(100%)patients
(both p<0.01). There were persistent problems with compliance in ointment group related to slow
healing ( 42(67.74%) patients} and longer time needed for symptomatic relief ( 50(80.64%) patients}.
Minor incontinence was (4.54%) in sphincterotomy group and none inointment group (p>0.05).
CONCLUSION: lateral partial internal sphincterotomy is an effective first line management for chronic
anal fissure. This has excellent symptoms relief, a better healing response and low recurrence rates.
KEYWORDS: Anal fissure, sphincterotomy, 0.2% GTN ointment
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