Title: Comparative Study of Pharmacotherapy, Outpatient CLAS and CLAS with Anal Stretching for Anal fissure Treatment
Author: Anurag Chittora
DOI: https://dx.doi.org/10.18535/jmscr/v6i8.85
Abstract
Background: Fissure in ano is a linear ulcer of the lower half of the anal canal, usually located in the posterior commisure in the midline. Fissure presents with anal pain, spasm and/or bleeding with defecation.
Objective: To determine the best treatment option for anal fissure acute or chronic in terms of relief in pain, bleeding and pain free defecation.
Methods: Retrospectively, I randomly selected 180 patients being treated for anal fissure between the Sept 2016 –July 2018 in 3 equal groups. Group A: Patient who received medical treatment and presenting illness less than 1 month. Group B: Patients treated with outpatient CLAS and presenting illness more than 1 month but less than 2 months. Group C: Patients treated with CLAS and Anal stretching and presenting illness like group B.
Result: The result were then correlated with the statistical program SPSS using chi-square test. Main presenting complain in all three groups is anal pain with burning, painful defecation and occasional bleeding. The response to treatment for relieving pain was 56% in A, 73% in B and 88% in C. Response of treatment for healing of fissure was 44% in A,64%in B and 91% in C.
Conclusion: Despite fairly good response to medical treatment surgical treatment was more effective. Outpatient CLAS alone is effective in acute fissure but combined CLAS with Anal stretching is more effective in chronic anal fissures.
Keywords: Acute fissure,Chronic fissure,Closed Lateral Anal Sphincterotomy (CLAS)
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