International Journal of Surgery and Surgical Research

International Journal of Surgery and Surgical Research


International Journal of Surgery and Surgical Research
International Journal of Surgery and Surgical Research
2019, Vol. 1, Issue 1
Comparative studies between medical and surgical treatments for chronic anal fissures: An article review

Dr. YN Irkal, Dr. Amrut Hirulal Basava

Anal fissure is a painful anorectal disorder with a tear in the anoderm, commonly caused by constipation. It accounts for 14-36% of anorectal disorders with lifetime risk of 11%. It causes severe discomfort and affects the quality of life. Chronic anal fissures (>6 weeks) are clinically associated with indurated margins, fibrotic base, exposed internal anal sphincter fibres, sentinel piles (skin tags) and hypertrophic anal papilla. The spasm of the internal anal sphincter leading to increased anal pressure, is the main reason for non-healing of fissure and chronicity. Treatment is aimed at relieving resting anal canal pressure and facilitating the blood flow for fissure healing. Medical treatment, termed as “chemical sphincterotomy”, includes commonly used topical agents like nitrates (0.2% glyceryltrinitrate), calcium channel blockers (2% diltiazem) and botulinum toxin injections. High fiber diet, fiber supplements, stool softeners, sitz baths and plenty of fluid intake are supportive treatments. Surgical treatment includes Lateral internal anal sphincterotomy (LIS) and anal dilatation; LIS being gold standard. This review includes five comparative studies between medical and surgical treatments for chronic anal fissures. Medical treatment involved twice daily topical application of glyceryltrinitrate/diltiazem, whereas surgical treatment involved LIS under spinal anaesthesia. The duration of follow-up was about 6-8 weeks. Complete pain relief varies between 64% to 92.5% with medical treatment, whereas 96% to 100% with surgical treatment. Fissure healing rates varies between 72% to 92.5% with the medical treatment, whereas 93% to 100% with the surgical treatment. Surgical treatment (LIS) has statistically significant better pain relief and fissure healing compared to medical treatment. Medical treatment is a safe first choice, but has high recurrence/failure rates. Diltiazem is preferable to glyceryltrinitrate. LIS is the most efficacious treatment with highest healing rates and lowest failure rates, but associated with self-subsiding complications like perianal hematoma or incontinence (9%).
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How to cite this article:
Dr. YN Irkal, Dr. Amrut Hirulal Basava. Comparative studies between medical and surgical treatments for chronic anal fissures: An article review. International Journal of Surgery and Surgical Research, Volume 1, Issue 1, 2019, Pages 16-18
International Journal of Surgery and Surgical Research