Long-term clinical and manometric comparison between surgical and chemical sphincterotomy for treatment of chronic anal fissure

Comparison between surgical and chemical sphincterotomy for treatment of chronic anal fissure. 160 patients were equally randomly divided into 4 groups treated by: lateral internal sphincterotomy [Group], local Diltiazem ointment [Group[22]], local Glyceryl trinitrate ointment [Group[222]], or injection of Botulinum toxin into the internal anal sphincter [Group 2V]. Anal manometry was measured before and 3 months after treatment. Patients were followed up for 5 years. Mean time for complete pain relief was 5.68 +/- 7.77 days [Group I], 15.7 +/- 5.87 days [Group II], 15.6 +/- 5.90 days [Group III] and 2.67 +/- 3.60 days [Group IV]. Mean healing time was 4.48 +/- 1.20 weeks [Group I], 5.12 +/- 1.13 weeks [Group II], 5.00 +/- 1.12 weeks [Group III] and 5.06 +/- 1.31 weeks [Group IV]. Mean resting and squeeze anal pressures decreased significantly after sphincterotomy. Recurrence rate was 10% in Group I, 65% in Group II, 57.5% in Group III and 52.5% in Group IV. Lateral internal sphincterotomy is easy and satisfactory, with minimal complications and recurrence. Medical sphincterotomy is safe, and easy, with mild complications. Its effect is reversible. Relapse after it is common. It is worth trial before surgery or in patients that cannot or unwilling to undergo surgery

Evaluation of endoscopic band ligation plus argon plasma photocoagulation versus scleroligation for eradication of esophageal varices: a prospective randomized controlled study

Bleeding from esophageal varices is the most severe and lethal complication of portal hypertension. The aim of this work was evaluation of the technique of endoscopic band ligation plus argon plasma photocoagulation versus scleroligation as a new method used for eradication of esophageal varices. This study was conducted on 200 patients out of 294 studied patients. Patients who fulfilled the inclusion criteria were randomized to four groups, Group I: comprised of 50 patients who were subjected to endoscopic injection sclerotherapy, Group II. comprised of 50 patients who were subjected to variceal band ligation, Group III comprised of 50 patients who were subjected to combined endoscopic sclerotherapy and band ligation, Group IV comprised of 50 patients who were subjected to endoscopic band ligation plus argon plasma photocoagulation. Comparison of the endoscopic number of therapeutic session between different studied groups showed that group III was significantly lower in number of sessions. As regard post treatment complications during the follow up period, Group I showed the high incidence of transient pyrexia, transient dysphagia and/or retrosternal pain and ulceration, while group II showed the higher incidence of re-bleeding was demonstrated. The higher incidence of recurrence rate of esophageal varices after eradication during the follow up was detected in group II, while the higher mortality incidence was detected in group I and II, In this study the follow up incidence did not significantly differ between the different studied groups. Scleroligation allows very rapid eradication of varices, low recurrence rate, avoided the disadvantage of high recurrence of band ligation alone, and did not require special skill over sclerotherapy or band ligation but the total cost is higher than that required for sclerotherapy. Also, Band ligation plus argon plasma photocoagulation allows very rapid eradication of varices, and low recurrence rate, with no obvious recorded complications, but it has the disadvantage of being the most expensive technique and requires special machine which is not available except in few endoscopic centers