RESUMEN
Background: Surgical management of non-suppurative perianal conditions are associated with intense pain in the postoperative period. Day case surgeries are often not possible for such conditions due to the need for post operative analgesia. The addition of pudendal nerve block lessens the post operative pain and hence avoids the need for opioids and its side effects. Aim: To assess the effectiveness of Pudendal nerve block in post -operative pain following perianal surgery for non suppurative conditions. Methods and material: Prospective cohort study. Patients undergoing surgical modality for anal fissures and hemorrhoids are divided into two groups. Group A receives pudendal nerve block (local infiltration) along with Spinal anaesthesia. Group B receives only Spinal anaesthesia. Post-operative pain (visual analog score) was analyzed and results compared. Results: It was found that there was a statistically significant association between being given pudendal nerve block and the need for analgesics post operatively. Conclusion: Pudendal block with local infiltration, if properly administered has excellent results with regard to patient’s pain tolerance, postoperative outcome and probable cost effectiveness. We conclude that the addition of pudendal nerve block with spinal anesthesia for non-suppurative anal conditions reduces the post operative pain and avoids the need for opioids and its side effects. It is safe and effective and it lessens the duration of hospital stay there by providing the patient with less stress of staying in the hospital for longer periods.
RESUMEN
Anal fissures are often encountered in surgical practice in both sexes. It is a distressing disease impacting quality of life and causes profound morbidity among those affected. If left untreated, it may lead onto perianal abscess or even malignancy in long standing cases. Surgery is the gold standard management for chronic anal fissures. Recently the widespread use of pharmacologic agents for chronic fissures has increased. The management of chronic anal fissures has migrated to an era of multifaceted approach. This narrative review looks into various studies spanning over a period of 16 years. Various articles were shortlisted and analyzed for efficacy of various treatment methods, their impact in hospital stay, quality of life improvement, recurrence rate and complications among various treatment methods. We concluded from this review, that open lateral internal sphincterotomy is still the gold standard method of treatment for chronic anal fissure. Among pharmacological agents, 2% diltiazem has the best effectiveness with good compliance rate. Modern surgical techniques like VY plasty can be reserved for special situations. We do not recommend the practice of manual anal dilatation.
RESUMEN
Background: Chronic anal fissure is a familiar entity in surgical outdoor departments of hospitals in our valley. The muslim women are usually reluctant to expose their anal canal related pathologies to male surgeons, letting anal fissures to reach the chronic stage. Under this background, the present study was conducted to look for the feasibility of lateral anal sphincterotomy in the management of chronic anal fissure in our patients.Methods: This prospective study was carried out over a period of 3 years in the unit 2nd of department of surgery at SMHS (Shri Maharaja Harisingh) hospital, an associated hospital of Government Medical College Srinagar. During this period, 59 patients presented to the outpatient department with typical chronic anal fissures and were included in this study.Results: Fifty-nine patients, diagnosed on clinical evaluation as chronic anal fissure were included in this study. The age varied from 19 to 58 years with mean age of 36.38±7.14 (SD= 7.14) years. There was a female predominance, with a female to male ratio of 2.1:1. Fifty-two (88.1%) patients had posterior midline fissure and 7 (11.8%) patients had an anterior anal fissure. Thirty-one patients were not satisfied with the conservative treatment and insisted for surgical management. All 31 patients were managed by open lateral anal sphincterotomy.Conclusions: Lateral anal sphincterotomy (LAS) is a safe and effective method of management for chronic refractory anal fissures. The complications are minimal and negligible.
RESUMEN
Anal fissure is common cause of anal pain. Exact aetiology of anal fissure is not known, but it is commonly seen due to constipation and hypertonic anal sphincter conditions. Studies on the method of treatment of anal fissure ranges from medical application to surgery. We have study of 200 cases of fissure in Ano for comparing in between treatment options of anal dilatation (AD) and lateral anal sphincterotomy (LAS). Patients were divided in two groups by randomly. In our study it has been shown that all the patients after anal dilatation significantly reduces the anal pain and provide symptomatic relief that is slightly better than lateral anal sphincterotomy