چکیده (انگلیسی):

Background: Anal fissure is a common benign condition. An anorectal problem is
defined as a split in the anal canal mucosa that extends from the dentate line to the anal verge.
Chronic anal fissure is defined by a history of symptoms present for more than 2 months’ duration
and with a triad of external skin tags, namely, a hypertrophied anal papilla, an ulcer with rolled
edges, and a base exposing the internal sphincter. Because complications such as incontinence
are associated with surgical treatment, chemical sphincterotomy is currently favored.
Objectives: The objective of this study is to compare the difference in outcome between open
partial lateral anal sphincterotomy and application of topical 0.2% nitroglycerin ointment for
the treatment of chronic anal fissure.
Methods: This was a quasi-experimental study carried out between January 16, 2007 and January
15, 2008 in the Surgical Department of Jinnah Hospital, Lahore, Pakistan. Sixty consecutive cases
with a clinical diagnosis of chronic anal fissure were recruited in the study. All recruited patients
met the study inclusion criteria and were randomly assigned to one of the two groups. Group A
was managed conservatively using topical 0.2% nitroglycerin ointment, whereas Group B underwent
open partial lateral anal sphincterotomy. Both groups were followed up at 1 week, 2 weeks,
4 weeks, and 6 weeks after the treatment.
Results: All the patients complained of pain. A total of 43 (71.7%) patients had pain with constipation,
whereas 31 (51.7%) patients had bleeding per rectum. Upon clinically examining the anal
area, tenderness was elicited in all 60 (100%) patients. Group A included 30 (11 females and 19
males) cases treated with topical 0.2% nitroglycerin ointment and Group B included 30 (11 females
and 19 males) cases who underwent open partial lateral anal sphincterotomy.
In Group A, only 15 patients with fissures were successfully treated (50%). By contrast, 28 (93%)
patients with fissures in Group B were successfully treated, and only two (7%) remained uncured.
These two patients (6.6%) in Group B suffered from incontinence due to flatus and feces as a
complication of the procedure.
Conclusion: This quasi-experimental study demonstrates that open partial lateral internal
sphincterotomy is superior to topical 0.2% nitroglycerin application in the treatment of chronic
anal fissure, with good symptomatic relief, high rate of healing, fewer side effects, and a very
low rate of early continence disturbances.