| Abstrakt: |
BACKGROUND: While 0.2% topical Glyceryl Trinitrate has been extensively studied for managing chronic anal fissures, less attention has been paid to its specific application methodology, dosage, and patient compliance, potentially contributing to higher recurrence rates and lower cure rates. This study addresses these gaps by comparing the healing outcomes of chronic anal fissures treated with 0.2% Glyceryl Trinitrate (chemical sphincterotomy) versus surgical lateral internal sphincterotomy (surgical sphincterotomy) as its primary objective. Secondary objectives include assessing pain relief, reduction in rectal bleeding, risk of incontinence, and recurrence rates associated with both treatment methods. AIM AND OBJECTIVE: 1. To determine the age and gender distribution of anal fissure incidence. 2. To examine the various clinical presentations and types of anal fissures. 3. To assess the efficacy of 0.2% topical Glyceryl trinitrate in relieving symptoms and promoting healing of anal fissures. 4. To compare the effectiveness of lateral anal sphincterotomy versus chemical sphincterotomy in treating anal fissures. 5. To evaluate the potential of Glyceryl trinitrate as a primary treatment option for both acute and chronic anal fissures. PATIENTS AND METHODS: The clinical trial was conducted at Maharaja Krushna chandra Gajapati Medical College and Hospital, Berhampur between June 2022 to June 2024. Patients presented with severe cutting pain during defecation and bleeding per anum lasting over six weeks. Clinical examination included gentle separation of the buttocks to examine the anus for a linear ulcer in the anoderm, with or without a sentinel pile, after taking proper consent. INCLUSION CRITERIA Consenting patients aged 18 to 65 years with symptomatic chronic fissure in ano were included. Extreme age groups were excluded to avoid age-related bias. EXCLUSION CRITERIA a. Pregnant or lactating; b. Inflammatory bowel disease, tuberculosis, malignancy, or sexually transmitted diseases; c. Undergone prior anal surgery or were refractory to 0.2% topical glyceryl trinitrate; d. Associated haemorrhoids or fistula; e. Significant cardiovascular diseases; f. Opted for specific treatments (chemical/surgical). A total of 185 patients diagnosed with chronic anal fissure and attending the Surgical Out Patient Department were enrolled in the study. Patients were assigned to Group A or Group B based on an alternating pattern of odd and even patient numbers. - Group A (Chemical Sphincterotomy): Patients numbered 1, 3, 5, ..., 185 received treatment with 0.2% Topical Glyceryl Trinitrate. - Group B (Surgical Sphincterotomy): Patients numbered 2, 4, 6, ..., 184 underwent open lateral internal sphincterotomy under spinal or general anaesthesia as inpatients. The two groups were compared on various parameter like-Fissure Healing Rate, Recovery of Pain, Recovery of Bleeding per rectum, Recovery time, Risk of Anal Incontinence, Morbid aspects of the treatment, Recurrence rate, Work resume time, Conversion rate and conclusion were drawn. RESULTS: Surgical Sphincterotomy demonstrated statistically significant better healing compared to Chemical Sphincterotomy. Group A had an average pain score of 2.24, whereas Group B had a score of 0.55, indicating complete symptom resolution in Group B. Both groups showed early recovery by the 2nd week, with final recovery rates of 87.78% in Group A and 98.92% in Group B by the 10th week. Group A resumed work on average in 3.37 weeks, while Group B resumed in 3.19 weeks, showing no statistically significant difference. The average recovery time for fissure healing was 5.18 weeks in Group A and 4.84 weeks in Group B, indicating quicker recovery with Surgical Sphincterotomy. Group B had a higher incidence of fecal incontinence (29.03%) compared to Group A (2.22%, temporary). There was no recurrence in Group B, establishing it as the gold standard treatment. Group A had a recurrence rate of 6.67% and a conversion rate of 16.67%, indicating higher failure rates and the need to switch to surgical treatment. CONCLUSION: Surgical Sphincterotomy (Group B) showed superior recovery and treatment response compared to Chemical Sphincterotomy (Group A), despite a higher incidence of fecal incontinence. However, Chemical Sphincterotomy also demonstrated good recovery with less morbidity. [ABSTRACT FROM AUTHOR] |
