Anal fissures are common causes of morbidity
in the surgical units. The severe pain during and after defecation greatly
impacts on the quality of life of many
patients. Acute anal fissures responds poorly to medical treatment and are
therefore best managed using surgical methods. Lateral internal sphincterotomy
is the gold standard in the treatment of anal fissures.
compare the efficacy of chemical and surgical lateral internal sphincterotomy
in patients of acute anal fissure.
Methods: A Randomized controlled trial conducted at Department of Surgery,
Unit-II, Fatima Memorial Hospital, Lahore. The duration of the Study was over a
period of six months from 10-09-2018 to 09-03-2019.A total of 100 patients (50
in each group) were included in the study. Group-A was treated with chemical
sphincterotomy local application of glyceryl trinitrate 0.2 percent ointment
and Group-B was treated with surgical lateral internal sphincterotomy.
Results: Patients were ranged between 15-60 years of
age. Mean age of the patients was 36.64±10.05 and 33.42±11.47 in group-A and B,
respectively. In group-A 13 patients (26%) and in group-B 15 patients (30%)
were male and 37 patients (74%) in group A and 35 patients (70%) were female.
Efficacy was observed in 16 patients (32.0%) of group-A and 50 patients (100%)
of group B. There was a statistically significant difference between two groups
Conclusion: In conclusion, surgical sphincterotomy was
significantly more effective in providing postoperative pain relief
(p<0.001). However, chemical sphincterotomy is a non-invasive,
cost-effective, easier to apply, well-tolerated and effective therapy for anal
fissure and is a first line treatment especially in patients who are unwilling
or unfit for surgery.
Key words: Chemical sphincterotomy, lateral
internal sphincterotomy, Acute anal fissure