Surgery as a preferred modality of treatment for the patients of chronic anal fissure with sentinel piles

ABSTRACT

To find out the preferred modality of treatment by patients having chronic anal fissure with sentinel pile. Prospective, Observational Study. This study was conducted at the Department of Surgery, Baish General Hospital, Kingdom of Saudi Arabia from January 2008 to December 2011. Forty eight patients had chronic anal fissures associated with sentinel piles. They had been explained the multiple modalities of treatment available along with their advantages and disadvantages. Some patients preferred surgery as 1[st] line of treatment while others conservative. Lateral sphincterotomy associated with fissurectomy was the surgical procedure applied, while 0.2% GTN cream as conservative modality. Out of total 48 patients, 39 were treated by surgery [P=0.2]. Thirty two [Group-A] were treated by surgery as 1[st] line of treatment [P=0.2], while 7 [Group-C] as 2[nd] line after failure with 0.2% GTN cream [P>0.05]. Healing rate and patients' satisfaction were excellent. A total of sixteen patients [41.02%] developed different post-operative complications, out of which, one patient [2.56%] had marked bleeding. One [2.56%] had transient flatus incontinence. Eight [20.51%] suffered from severe pain treated by opiate-derivative analgesic. Six [15.38%] had urinary retention. A total of 16 patients [Group-B] were initially treated conservatively with 0.2% GTN cream [P>0.05]. Out of 16, nine [56.25%] were quite satisfied with conservative treatment, while seven [43.75%] had failure and switched to surgery as 2[nd] line of treatment. None of the modality of treatment is without complications. Lateral sphincterotomy associated with fissurectomy is an effective treatment and gives patients a sense of satisfaction to the patient to get rid of sentinel pile