ABSTRACT
Surgical procedures including open and close lateral sphincterotomy were the main treatment of chronic anal fissure in past years. Nowadays, medical treatments are the standard therapy for this disease, but there are some limitations for this method of treatment. This study aimed to compare the efficacy and complication of surgical and medical treatments by lidocaine ointment for patients with chronic anal fissure. A clinical trial study was conducted on 180 patients with chronic anal fissure who had symptoms for more than 6 weeks. The main symptoms of patients were pain during defecation, anal bleeding and skin tag. After history taking and physical examination, method of treatment was explained for patients to choose one group: Group 1 [surgery] or group 2 [medical treatment with lidocaine H]. Surgery was performed by closed method. Medical treatment was consisted of high fiber regimen, sits baths, C-lax tablet nightly, Naproxen tablet 250 mg twice daily and 5% lidocaine anal application before defecation and anal washing during defecation. Patients were followed for 8 weeks. Data were analyzed using chi-square, Fisher and Mann-Whitney tests. One hundred of patients in group 1 and 80 patients in group 2 completed the study. Duration of symptoms was 8.1 +/- 2.5 weeks in group 1 and 7.9 +/- 3.1 weeks in group 2. Post operative complications in group 1 were skin ecchymosis [10%], large hematoma [2%] and 10 cases [10%] complained from mild incontinency to flatus. There was no complication in group 2. Healing rate was 93% in group 1 and 75% in group 2 [P<0.05]. Medical treatment with lidocaine is a safe and effective treatment for chronic anal fissure