Long-term prospective randomised clinical and manometric comparison between surgical and chemical sphincterotomy for treatment of chronic anal fissure
AbstractAIM: comparison between surgical and chemical sphincterotomy for treatment of chronic anal fissure. PATIENTS AND METHODS: 160 patients were equally randomly divided into 4 groups treated by: lateral internal sphincterotomy (Group І), local Diltiazem ointment (Group ІІ), local Glyceryl trinitrate ointment (Group ІІІ), or injection of Botulinum toxin into the internal anal sphincter (Group ІV). Anal manometry was measured before and 3 months after treatment. Patients were followed up for 5 years. RESULTS: 32 patients (80%) in Group I reported immediate pain relief, 28 patients (70%) in Group II reported pain relief by 2 weeks, 31 patients (77.5%) in Group III relieved by 2 weeks and 36 patients (90%) in Group IV had immediate pain relief. Mean resting and squeeze anal pressures decreased significantly after sphincterotomy. Recurrence occurred in 10% of Group I patients, 65% of Group II patients, 57.5% of Group III patients and 52.5% of Group IV patients. CONCLUSION: Lateral internal sphincterotomy is satisfactory, easy, and rapid, with minimal complications and recurrence. Medical sphincterotomy is accepted, safe, and easy, with mild side effects. Its effect is reversible, relapse after it is common. It is worth trial before surgery or in patients that cannot or unwilling to undergo surgery.
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