A Prospective Observational Study in the Management of Primary Fissure in Ano in a Tertiary Care Centre in Tamil Nadu, South India - A Single Institution Study

Balaji Subramaniam¹, Karthikeyan Selvaraj², Nivetha Munuswamy³, Hubert Cyril Lourdes Rozario⁴*, Gokul G⁵ and Gandhi Kanappan G^6
1Senior Resident, General Surgery Department, Sree Balaji Medical College & Hospital, Tamil Nadu, India
²Department of General Surgery, Sree Balaji Medical College & Hospital, Tamil Nadu, India
³Department of General Surgery, Sree Balaji Medical College & Hospital, Tamil Nadu, India
⁴Department of General Surgery, Sree Balaji Medical College & Hospital, Tamil Nadu, India
⁵Junior Resident, General Surgery Department, Sree Balaji Medical College & Hospital, Tamil Nadu, India
⁶Junior Resident, General Surgery Department, Sree Balaji Medical College & Hospital, Tamil Nadu, India
*Corresponding Author: Hubert Cyril Lourdes Rozario, Department of General Surgery, Sree Balaji Medical College & Hospital, Chrompet, Tamil Nadu, India.

Published: June 20, 2023

DOI: 10.55162/MCMS.05.140

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Abstract  

Fissure in Ano or Anal Fissure is a common Anorectal condition occurring in both genders across all age groups. It can be a very troubling condition because, if presented as acute, the severity of patient discomfort and extent of disability far exceeds that which would be expected from a seemingly trivial lesion.

In this study, we included 108 patients and divided them equally between three groups of 36 each. One group is treated surgically, while another group is treated medically by a non-randomized control study.

Group A - Surgically managed group. This group treated patients surgically with open partial lateral internal anal sphincterotomy. Patients treated surgically had few complications in the perioperative period, subsiding within 4 weeks.

 Patients treated surgically had few complications in the perioperative period.

Group B - Medically managed group. This group treated patients with a topical application of 0.2% Glyceryl Trinitrate (GTN). In this group after 1 month of treatment, patients who are not satisfied either discontinued treatment or required conversion to surgery. A complication of Glyceryl Trinitrate is a headache that occurs in most patients.

Group C - Conservatively managed group. Patients in this group were treated conservatively with a Sitz bath with Betadine and Topical application of 2% Diltiazem cream. In this group after 1 month of treatment, patients who are not satisfied either advised topical 0.2% GTN application or conversion to surgery. A complication of Diltiazem includes hypotension and itching at the site of application.

Result: Through this study, we conclude that surgical management has better outcomes in the treatment of primary fissure in Ano without any underlying disease.

Keywords: Ano-Rectal condition; Fissure in Ano; Glyceryl Trinitrate; Open partial lateral internal Anal Sphincterotomy; Diltiazem