A Prospective Interventional study between Chemical Sphincterotomy using 2% Topical Diltiazem and Surgical Internal Sphincterotomy in the management of Chronic Fissure in Ano

Balasubramanian, A (2016) A Prospective Interventional study between Chemical Sphincterotomy using 2% Topical Diltiazem and Surgical Internal Sphincterotomy in the management of Chronic Fissure in Ano. Masters thesis, ESIC Medical College & Post Graduate Institute of Medical Science and Research, Chennai.

[img]
Preview
Text
220149516balasubramanian.pdf

Download (2MB) | Preview

Abstract

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 so common that it affects 1 in 10 people and causes very disabling symptoms such as severe cutting type perianal pain & bleeding per rectum making the diseased to suffer intense mental &physical agony in spite of rest and analgesics. Also the chronic fissures 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 the well-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, Diltazem, a calcium channel blocker 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 2%Topical Diltiazem 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. With Results of the study we conclude that Chemical Sphincterotomy using 2% Topical Diltiazem is an effective alternative for the Gold standard Surgical Sphincterotomy and should be offered as a first line of treatment for the patients with chronic fissure in ano. Surgical sphincterotomy can be reserved for refractory cases alone considering its morbidity.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Chronic Fissure in Ano ; Chemical Sphincterotomy ; 2% Topical Diltiazem ; Surgical Sphincterotomy.
Subjects: MEDICAL > General Surgery
Depositing User: Subramani R
Date Deposited: 27 Sep 2017 04:00
Last Modified: 13 Dec 2017 02:38
URI: http://repository-tnmgrmu.ac.in/id/eprint/3395

Actions (login required)

View Item View Item