A COMPARATIVE STUDY BETWEEN EFFICACY OF TOPICAL NIFEDIPINE APPLICATION AND LATERAL SPHINCTEROTOMY IN CHRONIC FISSURE IN ANO

Abstract

Background: Anal fissure, is a common condition in the proctological disorders. In 1829 Recaimer was the first one to describe this condition. It is a tear in the anoderm vertically occurred in the anal canal between the dentate line and  the anal opening. It causes painful defecation, bleeding, and sphincter spasm. They can occur in all age groups, majorly in young people, with male preponderance. Most anal fissures are acute and heal by their own or with high fibre diet, stool softeners. Anal fissures which present for more than six weeks are called as CHRONIC ANAL FISSURES. In present study there is comparison of the use of topical nifedipine and lateral internal sphincterotomy in the treatment of chronic anal fissures in terms of efficacy in healing and complications.

Methods: This is A comparative study between efficacy of topical nifedipine application and lateral sphincterotomy in chronic fissures in ano which was conducted in SVRRGGH, TIRUPATHI for duration of 1 year from approval of Institutional Ethics Committee. For this study, cases presenting to the surgery OPD of all units of the Department of General Surgery with complaints like painful defecation with or without bleeding per rectum for more than 6 weeks are considered. To diagnose chronic anal fissure, a brief history is taken and a per-rectal examination is performed. Systemic and fundamental investigations were carried out. Patients are randomly assigned to either chemical or surgical sphincterotomy. Chemical sphincterotomy entails applying nifedipine gel to  the anal sphinter reg three times per day for eight weeks. Lateral Internal Sphincterotomy is the surgical treatment option. In the follow-up patients underwent per rectal examination, to assess the efficacy of the treatment and the complications associated with the treatment and the results were compared between the two groups.

Results: My study includes 100 patients admitted in SVRRGGH, TIRUPATHI and after informed and written consent and after thorough explanation of the procedure and its advantages and disadvantages the patients had undergone treatment. In my study from the above results we can conclude that lateral sphincterotomy is superior to nifedipine application in terms of symptomatic relief and healing and recurrence and it can be safely preferred as treatment of choice for early healing of fissures in medically fit patients. More prospective trials are needed to compare the full efficacy and complications in healing of chronic anal fissure with nifedipine and to safely prescribed as an alternative to surgical method.

Conclusion: In the present study it shows that results are towards the surgical method that is lateral sphincterotomy with a healing rate of 100% along with speedy recovery and pain-relief with minimal or no complications. Though local application of nifedipine is as effective as lateral sphincterotomy in the treatment of chronic fissure-in-ano there is delay in the relief of symptoms and lesions compared to internal sphincterotomy, with an insignificant adverse effects. Topical nifedipine can be safely prescribed for patients who are unfit or unwilling for surgical procedures. Though there is latency in healing rate compared to surgery but the necessity for hospital stay is removed and it also decrease in the psychological as well as financial burden on the patient. With a healing rate near to 90%, topical nifedipine therapy can be easily advised as the first line of treatment for  chronic anal fissure. By comparing the above two modalities of treatment for chronic anal fissure, we can conclude that Lateral sphincterotomy appears to be the better line of treatment as there is 100% healing rate with almost nil complications.