Chemical versus surgical sphincterotomy for chronic fissure in ano

ABSTRACT

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