11. COMPARISON OF EFFICACY OF LATERAL INTERNAL SPHINCTEROTOMY (LIS) VERSUS GLYCERYL TRINITRATE (GTN) IN THE TREATMENT OF CHRONIC ANAL FISSURE

Nisar Ahmed, Nadia Khitab, Rashid Waheed, Muhammad Muslim, Syed Asad Maroof, Mahmud Aurangzeb, Mushtaq Ahmad

Department of Surgery, Khyber Teaching Hospital, Peshawar - Pakistan

Abstract

Objectives: To determine the effectiveness of Glyceryl Trinitratepaste (GTN) versus Lateral Internal Sphincterotomy
(LIS) in treatment of chronic anal fissure in terms of pain relief and cessation of bleeding per rectum.
Material and Methods: This randomized control study was carried out in Surgical A Unit, Khyber Teaching Hospital,
Peshawar, Pakistan from May 2013 to April 2015. On the basis of convenient purposive sampling consecutive 110
patients with chronic anal fissure were selected from those came through outpatient department for anal pain and
bleeding per rectum. The patients were divided into 2 groups A (LIS) and B (GTN), by simple random sampling to
which either topical GTN treatment or surgery i.e. LIS were offered respectively, and were advised to follow up at 2nd
and 6th weeks. Patient’s symptoms were noted in proforma at each follow up.
Results: In group A in 98% patients the bleeding had stopped by 2 weeks and in 100% patients by 6 weeks postoperatively,
whereas in group B, the bleeding had stopped in 78% and 90% at 2 and 6 weeks respectively. The difference in
both groups was statistically significant. The mean pain scores in group A was 1.51±0.29(95% CI) compared to group
B as 3.93±0.38(95% CI) at 2 weeks; and pain scores of group A was 0.35±0.16(95% CI) as compared to group B as
2.11±0.37(95% CI). The difference in both groups was statistically significant.
Conclusion: Lateral Internal Sphincterotomy is the quick and effective method of management for chronic anal fissure
regarding improvement of symptoms as compared to medical treatment with Glyceryl Trinitrate treatment.

Keywords: Glyceryl trinitrate, lateral, internal sphincterotomy, chronic, anal fissure

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