Lateral internal sphincterotom; [for the treatment of fissure in-ano] [six years experience]

To evaluate the efficacy of lateral internal sphincterotomy in fissure in-ano. This study is a prospective clinical trial. it was conducted initially at D.H.Q./ Allied Hospital [PMC] Faisalabad and then other centers from November 2001 to onward for the period of six years. 140 patients, in urgency due to sever pain, non-compliance to conservative and pharmacological management, or their preference were treated by lateral internal sphincterotomy. The patients were followed up at 1 st to 12th weeks. The extent of improvement in presenting symptoms and complications were noted on questionnaires. Lateral internal sphincterotomy relieved 140 [100%] patients. Transient incontinence of flatus was present in 64.3%, at 1st week that was resolved at 8-12th weeks. There was no recurrence in other complications included infection 7.1%, abscess 7.1% and anesthesia related problems in 14.2%. Lateral internal Sphincterotomy may be regarded as [The Gold Standard]

Anal fissure; treatment with glyceryl trinitrate [five years experience]

To evaluate the efficacy of glyceryl trinitrate [GTN] preparation for the treatment fissure in-ano. This study is a prospective clinical trial. This was conducted initially at PMC Faisalabad and other centers from November 2001 to onward for the period of five years. Out of 306 patients, 42 disliked/ refused this modality of treatment and was launched on 264 patients. 114 patients never followed up so, were excluded from the study. The remaining 276 patients applied 0.2% glyceryl trinitrate preparation on their anal verge thrice a day for two months. The patients were followed up at 1[st] to 12[th] weeks. The extent of improvement in the presenting symptoms, side effects and complications were noted on questionnaires. A healing rate of 64.3%, and recurrence occurred in 35.7%. 72 patients demanded surgery after failure/ non-compliance of GTN ointment treatment. Glyceryl trinitrate preparation is a safe and effective modality for the treatment of fissure in-ano

Chemical versus surgical sphincterotomy for chronic fissure in ano

To evaluate the efficacy and costs of chemical [topical glyceryl trinitrate ointment] versus lateral internal sphincterotomy for the treatment of chronic anal fissure. A quasi-experimental study. This study was conducted at D.H.Q. /Allied Hospital, Faisalabad from November 2001 to October 2003. Out of 74 patients, topical treatment was applied to 46. Eighteen patients never followed this modality of treatment so were excluded from the study. The remaining 28 patients applied 0.2% glyceryl trinitrate ointment on their anal verge thrice-a-day for two months. The patients in urgency due to pain or refused topical modality were treated by surgical sphincterotomy. Twenty-eight patients were allocated to undergo surgical sphincterotomy. The patients were followed-up and the extent of improvement in presenting symptoms, side effects, complications and costs of these modalities were noted on the questionnaires. Chemical sphincterotomy relieved symptoms only in 18 [64.3%] patients while surgical sphincterotomy relieved 28 [100%] patients. In the former, recurrence occurred in 6 [33.3%] patients, but in the later group incontinence of flatus/ faeces was present in 18 [64.3%] at first week which resolved by eighth weeks. Wound related complications in 4 [14.2%] cases were noted. Average costs of treatments excluding hospital expenditures were Rs. 164 and Rs. 1244 respectively. Topical modality proved to be cost-effective and non-invasive than the surgical modality, but later was superior regarding healing of anal fissures