Chemical sphincterotomy versus surgical lateral sphincterotomy in the treatment of acute and chronic anal fissures

Anal fissure is a common condition that causes severe anal pain after defecation causing considerable morbidity and reduction in quality of life. The aim of this study was to evaluate the effectiveness of glyceryl trinitrate [GTN] 0.2% in the treatment of anal fissure and compare it with surgical lateral internal sphincterotomy. From November 2001 to April 2002, 40 patients were selected and divided into two groups: Group I treated by GTN [0.2%] and group II with surgical lateral sphincterotomy. Group I patients showed reduction of anal pain in 95% [9/10 acute and 4/10 chronic] with only one failure of treatment due to severe headache, 23% relapse rate after six months. Group II patients had reduction of pain in 100%, healing in 100% of cases and no relapse after six months follow up. It was concluded that internal lateral sphincterotomy is still the gold standard treatment, but GTN can be an alternative to internal lateral sphincterotomy, especially in acute anal fissures

safer splenectomy with critical thrombocytopenia: preoperative splenic artery embolization

Portal hypertension is sometimes associated with hypersplenism and pancytopenia. Splenectomy cures the hypersplenism in these circumstances. The presence of critical thrombocytopenia is usually associated with high morbidity and mortality of the splenectomy procedure. To evaluate the effect of preoperative splenic artery embolization on the outcome of splenectomy in these circumstances. From April 2000 to June 2002, 23 patients with pancytopenia associating portal hypertension were selected to be enrolled in the study. All patients had splenic artery embolization as a preoperative measure to improve their thrombocytopenic state. This was followed by a surgical splenectomy after reaching a platelet count above 100,000 /cm3. Post embolization all patients showed a progressive increase in platelet count from a mean of 51000/ cm3 to a mean of 122000/cm3 on day 6. Complications of the embolization procedure were bleeding at the puncture site, portal vein thrombosis, splenic abscess, and systemic sepsis. Complications of the splenectomy procedure were one mortality, post operative Heeding in one case, chest infection in one case and wound infection in 2 cases. Preoperative splenic artery embolization can be used to improve the outcome of splenectomy in the presence of thrombo-cytopenia. The technique should be used selectively and only when platelet counts drop below 50000/cm3 [critical thrombocytopenia]. Splenectomy timing at day 6 post embolization is safe as thrombocytopenia was corrected at that time in all patients