Arul Shakthi, S (2020) A Prospective Interventional study between Chemical Sphincterotomy using 0.2% Topical Glyceryl Trinitrate and Surgical Internal Sphincterotomy in the Management of Chronic Fissure in Ano. Masters thesis, Chengalpattu Medical College and Hospital, Chengalpattu.
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Abstract
BACKGROUND: Fissure in ano is the most common painful condition of perianal region,characterized by longitudinal ulcers affecting the distal part of the anal canal. It’s socommon that it affects 1 in 10 people and causes very disabling symptoms such assevere cutting type perianal pain & bleeding per rectum making the diseased to suffer intense mental &physical agony in spite of rest and analgesics. Also the chronicfissures behave more differently in that way they are more persistent and relapsing than the Acute fissures which are self-healing. Much has been already discussed in the literature regarding the aetiology of Fissures though the Persistent Hypertonia of the anal sphincters is claimed to be thewell-established cause. And so the available standard treatment options targets at relieving the spasm of the internal anal sphincter with surgical or chemical methods. Gold standard in the management of the Chronic fissure in ano is the time proven, Lateral Internal Sphincterotomy with healing rates above 95%. But the need for the alternative is always been there to overcome the surgical stress and risk of incontinence. Here we have different chemicals which do the same job of relaxing the tone of internal sphincter by their special properties. Of which, 0.2% GTN with its unique profile of better healing rates and least side effects is been used in its topical form locally. The present study has compared the healing rates of Chronic fissure in ano using 0.2%Topical GTN with the Surgical Sphincterotomy. It also compares and analyses the other secondary objectives namely the recovery of Pain, Bleeding per Rectum, risk of Incontinence and the recurrence rates in both the methods. So we will study both the techniques and their standing in present scenario. With the background of experience in surgical sphicterotomy we will commence our work on chemical management of fissure in Ano. OBJECTIVES: 1. To find the age and the sex incidence of fissure in ano. 2. To study the various modes of clinical presentation of fissure in ano and the various types of fissure in ano. 3. To evaluate the effectiveness of topical 0.2% Glyceryl trinitrate in the symptomatic relief and healing of anal fissures. 4. To compare the effectiveness of lateral anal sphincterotomy and chemical sphincterotomy in fissure in ano. 5. To establish the role of glyceryl trinitrate as the first line treatment for both acute and chronic fissures. MATERIALS AND METHODS: Source of data: Study is a prospective type which includes all patients admitted in CHENGALPATTU MEDICAL COLLEGE for management of fissure in Ano. Method of collection of data (including sampling procedure if any: Definition of a study subject: Patients subjected to this study were taken form surgical unit of Chengalpattu Medical College and Hospital, Chengalpattu over a period of one year. From January 2018 to December 2018. Sample Size: 150. Chemical method: 75. Surgical method: 75. The method of study consists of: Detail history taking & clinical examination as per the proforma Investigations after taking written informed consent Patients will be explained about types of management available-chemical management and sphincterotomy. Post operative period will be divide into immediate or in hospital stay and follow up period during in hospital stay, following data will be collected. Post operative hospital stay. Any complication if occurred. Patients of both groups will be followed regularly up to 3 months Note will made of any complications, time taken to return to work and patients satisfaction. Inclusion criteria: Consenting patient between 16 to 65 years of age with symptomatic chronic fissure in ano among the population where included in the study extreme of age not included due to possibility of age related bias Exclusion criteria: Pregnancy, Major bleeding disorder, IBD/TB/ Malignancy/ STD, Prior anal surgery, Previously refractory to 2% GTN Associated haemorrhoids, fistula. Patients with specific cardiovascular diseases. The following investigations will be done after taking written informed consent- 1. Routine Investigations for General Surgical Procedure Blood Investigation and Urine Investigations :Hb%, TC , DC, Peripheral smear, ESR, Renal function tests, Liver function tests, Lipid profile, FBS/PPBS, HIV, HBsAg, , Urine for albumin, sugars, ketone bodies, microscopy, BT CT. Other investigations : X-ray of the chest, , proctoscopy in chronic cases. CONCLUSION: The above study is to evaluate the efficacy of chemical and surgical management of fissure in ano in Chengalpattu Medical College Hospital during the period Jan 2018 to December 2018.
| Item Type: | Thesis (Masters) |
|---|---|
| Additional Information: | 221711251 |
| Uncontrolled Keywords: | Chemical Sphincterotomy, 0.2% Topical Glyceryl Trinitrate, Surgical Internal Sphincterotomy, Management, Chronic Fissure in Ano. |
| Subjects: | MEDICAL > General Surgery |
| Depositing User: | Subramani R |
| Date Deposited: | 10 Feb 2021 17:01 |
| Last Modified: | 10 Feb 2021 17:01 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/14002 |
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