ABSTRACT
Background: The treatment of chronic anal fissure has changed greatly during the past two decades with ongoing research directed at lowering the internal anal sphincter tone and avoiding the risk of fecal continence disturbance. Glycerin trinitrate, topical calcium channel blockers and anal dilators and botulinum toxin injection alone are all known to be able to lower the internal anal sphincter tone but results have been disappointing in curing chronic anal fissure, often marginally better than to placebo. The surgical treatment in the form of lateral internal sphincterotomy is the gold standard for chronic anal fissure. Aims & Objective: The aim of this prospective study was to assess the efficacy of medical treatment in form of topical calcium channel blocker and surgery in the management of chronic anal fissure. The objective is to compare the efficacy with regard to complete healing, recurrence, incontinence and other complications after treatment with topical calcium channel blocker and lateral anal sphincterotomy. Material and Methods: From October 2010 to October 2012, 50 patients with typical chronic anal fissure completed the study. 25 patients were initially treated with topical calcium channel blocker for 8 weeks and rests 25 were treated with lateral anal sphincterotomy. During the follow-up healing rates, symptoms, incontinence scores, and therapy adverse effects were recorded. Results: Overall healing rates were 60% after 8 weeks therapy with topical calcium channel blocker. Whereas overall healing after lateral internal sphincterotomy group was 88% with no recurrence. Conclusion: Lateral internal sphincterotomy is far more effective than medical treatment, with significantly increased healing rates while avoiding risk of incontinence.
ABSTRACT
Background: The peptic perforation is one of the commonest abdominal surgical emergencies. Common causes are H.pylori, increased inadvertent use of NSAIDS, smoking and stress of modern life. During last few years there has been great revolution in availability of the newer broad spectrum antibiotics, better understanding of disease, effective resuscitation, prompt surgery under modern anaesthesia techniques, and intensive care unit resulted in reducing the mortality. Aims & Objective: To study the recent trends in peptic perforation. Material and Methods: This prospective study was carried out in the department of surgery during period from 1st May 2009 to 30th November 2011. All were indoor patients with diagnosis of peptic perforation in stomach and/or duodenum excluding other sites. Each patient was study in detail with relevant clinical history, examination, laboratory investigations and management. The study comprised of total 50 patients operated for peptic perforation by various modalities. Results: The middle age group was commonest. Smoking, alcohol and stress were common etiological factors. The perforation was common in anterior surface of the first part of duodenum. Wound infection and bronchopneumonia were common post-operative complications. Conclusion: The duration of perforation more than 24 hours and size of the perforation more than 1 cm has increase morbidity & mortality. Early diagnosis and prompt management of shock & septicaemia is important for better prognosis of patients. The simple closure with omentopexy of peptic perforation still remains the first choice as a treatment. H-pylori eradication treatment is mandatory after simple closure of the perforation to prevent recurrence of ulcer.