Subcutaneous internal lateral sphincterotomy (SILS) versus nitroglycerine ointment in anal fissure: a prospective study.
OBJECTIVE
To compare the results of subcutaneous internal lateral sphincterotomy under local anesthesia and nitroglycerin ointment treatments in acute and chronic anal fissures.


METHODS
This was a comparative, prospective study of 340 patients of acute and chronic anal fissure. The patients voluntarily opted either for the surgical procedure under local anesthesia, or the nitroglycerin treatment. All the patients were followed with regular checkups and complaints were documented.


RESULTS
Except for 1.75% patients having bleeding/hematoma formation, and with a dropout of 2.60% patients, no failure, recurrence or long term complications like incontinence, were observed in patients who underwent subcutaneous internal lateral sphincterotomy after a mean follow up of 28 months. With surgical treatment pain, bleeding per rectum and constipation showed significant improvement as compared to nitroglycerin treatment. Fissure healing was 100% in surgical group as compared to 56.90% in medical group (P=0.000, odds ratio=344.6). Nitroglycerin was equally effective in acute and chronic fissures (P=0.096).


CONCLUSIONS
Subcutaneous internal lateral sphincterotomy under local anesthesia is more curative, easy and safe, in the hands of a beginner as well as an experienced surgeon, with highest patient satisfaction, and should be considered as the first line of therapy in both chronic and resistant/recurrent acute anal fissures.
Department of General Surgery, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, J&K 190011, India. drrathershiraz@yahoo.com
Shiraz Ahmad
SA
Rather
Tanveer Iqbal
TI
Dar
Aijaz Ahmad
AA
Malik
Aijaz Ahmad
AA
Rather
Asima
A
Khan
Fazal Q
FQ
Parray
Rauf Ahmad
RA
Wani
D000328:Adult; D001003:Anal Canal / Q000601:surgery*; D005260:Female; D005401:Fissure in Ano / Q000188:drug therapy / Q000601:surgery*; D006801:Humans; D008297:Male; D005996:Nitroglycerin / Q000008:administration & dosage* / Q000009:adverse effects; D009824:Ointments; D010349:Patient Compliance; D011183:Postoperative Complications; D014665:Vasodilator Agents / Q000008:administration & dosage* / Q000009:adverse effects
D009824:Ointments; D014665:Vasodilator Agents; D005996:Nitroglycerin