ABSTRACT
Background: Anal fissure is painful condition, with reduced quality of life for patients
Objective: To evaluate the efficacy of medical therapy versus lateral internal sphincterotomy for the treatment of patients with acute and chronic anal fissure
Patients and Methods: This was a comparative prospective study of 122 patients of acute and chronic anal fissure, conducted at Bahawal Victoria Hospital Bahawalpur, during a period of 2 years from 1[st] July, 2011 to 30[th] June, 2013. Medical therapy [Group A] was advised to 122 patients [32 patients with acute anal fissure and 90 patients with chronic anal fissure] with pain killer, stool softener, high fibre diet and 0.2% glyceryltrinitrate ointment applied at fissure site, thrice a day for eight weeks. The lateral internal sphincterotomy [Group B] was done in 47 patients. Patients with inflammatory bowel disease, pregnant women and patients taking nitrates for other condition were excluded. The patients were followed up, to assess fissure healing, complications and compliance for 6 months
Results: 29 [90.63%] patients with acute anal fissure and 46 [51.11%] patients with chronic anal fissure were cured by medical therapy and 45 [95.74%] out of 47 patients who did not respond to medical therapy were cured with lateral internal anal sphincterotomy [LIAS]. Headache was the main complaint in medical group while postoperative anal itching [10.64%], fecal soiling of clothes [8.51%] and transient flatus incontinence 3 [6.38%] were main complaints and one [2.13%] patient of permanent fecal incontinence was seen in group B
Conclusion: As the medical therapy is simple, achieves satisfactory healing rates, the authors suggested this as the first line of treatment for anal fissures as it could be prescribed by the general practitioner in the absence of any additional anal pathology. Patients unresponsive to medical therapy can then be referred for lateral internal sphincterotomy