Abstract
Introduction: Anal fissure is a common condition affecting all age groups, but it is seen particularly in young and otherwise healthy adults, with equal incidence across the genders. Glyceryl Tri Nitrate(GTN) is an NO donor which causes relaxation of internal anal sphincter and increases blood flow to allow the fissure to heal. Lateral internal anal sphincterotomy is the most common treatment for chronic anal fissure and can be effective.
Aims and Objectives
- To study the aetiology and predisposing factors, age and sex incidence, clinical presentation, position of fissure and associated features.
- To study complications associated with medical and surgical management of anal fissure and to compare Glyceryl TriNitrate (0.2%) over Lateral Internal anal sphincterotomy.
Materials and Methods: Study Population was made of 60 patients who presented with chronic anal fissure, divided into two groups. Group A included 30 patients with chronic anal fissure treated with local glyceryl trinitrate ointment 0.2% whereas Group B included 30 patients managed by lateral internal sphincterotomy.
Results: Out of 60 study participants, 39 were male and 21 were female. Most of these patients had constipation as the major predisposing factor. 18 out of 30 patients had relief of symptoms with medical management. 27 out of 30 patients had relief of pain and healing of fissure with surgical management.
Conclusion: Lateral sphincterotomy remains effective but should be reserved for the patients who fail to respond to initial chemical sphincterotomy or GTN therapy.
Keywords: Anal Fissure, Glyceryl Tri Nitrare (GTN), Lateral Internal Anal Sphincterectomy (LIAS), Medical, Surgical.
References
- Keighley M, Williams N. Surgery of the anus, rectum and colon. Elsevier Pub. 3rd edition. 2008; 1:383.
- Kennedy ML, Sowter S. Nguyen H, Lobowski DZ. Glyceryl trinitrate ointment for the treatment of chronic anal fissure: results of a randomized placebo controlled trial. Dis Colon Rectum. 1999; 42:1000-6.
- Farouk R, Duthie GS, MacGregor AB, Bartolo DC. Sustained internal sphincter hypertonia in patients with chronic anal fissure. Dis Colon Rectum. 1994;37:424-9
- Lund JN, Scholefield JH. Glyceryl trinitrate is an effective treatment for anal fissure. Dis Colon Rectum. 1997; 40:468-70.
- Utzig MJ, Krosean AJ, Buhr HJ. Concepts in pathogenesis and treatment of chronic anal fissure-a review of literature. Am J Gastroenterol 2003; 8(3): 968-974.
- Nelson R. Non-surgical therapy for anal fissure. Cochrane database Syst Rev. 2006; 18(4):CD003431.
- Oh C, Divino CM, Steinhaqen RM. Anal fissures 20 years’ experience. Dis Colon Rectum 1995; 38:378–382.
- Christie A, Guest JF. Modeling of Economic impact of managing a chronic anal fissure, with proprietory formulation of nitroglycerin (rectogesic) compared to lateral internal sphincterotomy in UK. Int J Colorectal Dis 2002; 17(4):259–267.
- Richard CS, Gregoire R, Plewes EA, Silverman R, Burul C, Buie D, Reznick R, Ross T, Burnstein M, O’Connor BI, Mukraj D, Mc Leod RS. Internal sphincterotomy is superior to topical nitroglycerine in the treatment of chronic anal fissure: results of a randomised controlled trial by the Canadian Colorectal Surgical Trials Group. Dis Colon Rectum. 2000. 43(8):1048–1057.
- Lund JN, Armitage NC, Scholefield JH. Use of glyceryl trinitrate ointment in treatment of anal fissure. Br J Surg. 1996; 83 (6):776–777.
- Schouten ER, Briel JW, Boerma MO, Auwerda JJA, Wilms EB, Gratsma BH. Pathophysiological aspects and clinical outcome of intra anal application of isosorbide dinitrate in patients with chronic anal fissure. Gut. 1996; 39(3):465-9.
- Palazzo FF, Kapur S, Steward M, Cullen PT. Glyceryl trinitrate treatment of chronic fissure in ano one year’s experience with 0.5% GTN paste. J R Coll Surg Edinb. 2000; 45:168-70.
- Mishra BM, Tripathi P, Mishra JM, Debata PK, Panda BK. Comparative study of Glyceryl trinitrate (GTN) ointment versus surgical management of chronic anal fissure. Antiseptic. 2002; 99(5):150-3.
- Oettle GJ. Glyceryl trinitrate versus sphincterotomy for treatment of chronic fissure in ano. Dis Colon Rectum. 1997;40(11):1318-20.
- Lodder PB, Kamm MA, Nicholls RJ, Phillips RK. Reversible chemical sphincterotomy by local application of glyceryl trinitrate. Br J Surg. 1994; 81: 1386- 1389.
- Bhardwaj R, Parker MC. Modern perspectives in the treatment of chronic anal fissures. Ann R Coll Surg Engl 2007; 89:472-8.
Corresponding Author
Lakshmi Venkata Simhachalam Kutikuppala
Final MBBS Part-1, 156 batch, Department of General Surgery, Konaseema Institute of Medical Sciences and Research Foundation (KIMS&RF), Amalapuram, Andhra Pradesh, India, 533201
DOI: https://dx.doi.org/10.18535/jmscr/v7i7.131
