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VOLUME 5 , ISSUE 3 ( September-December, 2020 ) > List of Articles

Original Article

A Comparison of 0.3% Topical Nifedipine Ointment vs Lateral Sphincterotomy in the Treatment of Chronic Anal Fissure

Pradyot Shahi, Brijesh Sharma, Mahesh Solanki

Keywords : 0.3% Nifedipine ointment, Anal fissure, Lateral internal sphincterotomy

Citation Information : Shahi P, Sharma B, Solanki M. A Comparison of 0.3% Topical Nifedipine Ointment vs Lateral Sphincterotomy in the Treatment of Chronic Anal Fissure. J Mahatma Gandhi Univ Med Sci Tech 2020; 5 (3):77-82.

DOI: 10.5005/jp-journals-10057-0135

License: CC BY-NC 4.0

Published Online: 00-12-2020

Copyright Statement:  Copyright © 2020; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Introduction: A chronic anal fissure is a common anorectal condition associated with high sphincter pressure and a reduction in mucosal blood flow, with secondary local ischemia and a poor healing tendency. The principle of treatment is breaking the cycle of pain, spasm, and ischemia thought to be responsible for the development of fissure in ano. Aim: To assess and compare the topical application of 0.3% nifedipine and lateral internal sphincterotomy as treatment modalities in patients diagnosed with chronic anal fissure. Materials and methods: This study was a prospective comparative study where 100 patients who presented in a surgical outpatient department of MGMCH, Jaipur with complaints of the painful passage of stool, with or without bleeding of >6 weeks duration, diagnosed to be having chronic anal fissure, were randomly selected and classified into two groups, each consisting of 50 patients. The patients in the first group were subjected to pharmacological sphincterotomy using topical application of 0.3% nifedipine while patients in group II were subjected to lateral sphincterotomy. Outcomes in each group were followed up at 2, 4, 6, 8, and 12 weeks. Results: In our study, fissures at 4, 6, 8, and 12 weeks were healed in 78, 86, 92, and 90% patients, respectively, in the nifedipine ointment group whereas in the lateral sphincterotomy group fissures at 4, 6, 8 and 12 weeks had healed in 88, 92, 98, and 98% patients, respectively. Nineteen patients (38%) developed side effects in the nifedipine group, compared with 10 patients (20%) in the sphincterotomy group. Conclusion: With good treatment outcome nifedipine ointment has the potential to become the first-line treatment for chronic anal fissures. It represents a new, promising, effective alternative to lateral internal sphincterotomy but in case pharmacological therapy fails, lateral sphincterotomy is the surgical option of choice.


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  1. Gupta PJ. A review of ano-rectal disorders and their treatment. Bratisl Lek Listy 2006;107(8):323–331.
  2. Kodner IJ, Fry RD, Fleshman JW, et al. Colon rectum and anus. In: Schwartz's Principles of Surgery. 7th ed., USA: McGraw Hill Health Professions Division; 1999. p. 1265.
  3. Gordan PH. Fissure in ano. In: Gordon PH, Nivatvongs S, ed. Principles and Practice of Surgery for the Colon, Rectum and Anus. 2nd ed., St Louis: Quality Medical Publishing; 1999. pp. 217–240.
  4. Rosai J. In: Rosai and Ackerman's Surgical Pathology. 9th ed., St Louis: Elsevier; 2004. p. 858.
  5. Gibbons CP, Read NW. Anal hypertonia in fissures: cause or effect? Br J Surg 1986;73(6):443–445. DOI: 10.1002/bjs.1800730609.
  6. Bullard KM, Rothenberger DA. Colon, rectum and anus. Shwartz's Princip Surg 2005;8:28–1104.
  7. Madalinski M, Kalinowski L. Novel options for the pharmacological treatment of chronic anal fissure – role of botulin toxin. Curr Clin Pharmacol 2009;4(1):47–52. DOI: 10.2174/157488409787236083.
  8. Jensen SL, Lund F, Nielsen OV, et al. Lateral subcutaneous sphincterotomy versus anal dilatation in the treatment of fissure in ano in outpatients: a prospective randomised study. Br Med J (Clin Res Ed) 1984;289(6444):528–530. DOI: 10.1136/bmj.289.6444.528.
  9. Katsinelos P, Papaziogas B, Koutelidakis I, et al. Topical 0.5% nifedipine vs. lateral internal sphincterotomy for the treatment of chronic anal fissure: long-term follow-up. Int J Colorectal Dis 2006;21(2):179–183. DOI: 10.1007/s00384-005-0766-x.
  10. Motie MR, Hashemi P. Chronic anal fissure: a comparative study of medical treatment versus surgical sphincterotomy. Acta Med Iran 2016;54(7):437–440.
  11. Altomare DF, Binda GA, Canuti S, et al. The management of patients with primary chronic anal fissure: a position paper. Tech Coloproctol 2011;15(2):135. DOI: 10.1007/s10151-011-0683-7.
  12. Sarhan H. Closed versus open lateral internal sphincterotomy in treatment of chronic anal fissure: a comparative study. Arch Clin Exp Surg 2012;2012(1):219–223. DOI: 10.5455/aces.20120522101831.
  13. Golfam F, Golfam P, Golfam B, et al. Comparison of topical nifedipine with oral nifedipine for treatment of anal fissure: a randomized controlled trial. Iran Red Crescent Med J 2014;16(8):e13592. DOI: 10.5812/ircmj.13592.
  14. Perrotti P, Bove A, Antropoli C, et al. Topical nifedipine with lidocaine ointment vs. active control for treatment of chronic anal fissure. Dis Colon Rectum 2002;45(11):1468–1475. DOI: 10.1007/s10350-004-6452-1.
  15. Ram E, Vishne T, Lerner I, et al. Anal dilatation versus left lateral sphincterotomy for chronic anal fissure: a prospective randomized study. Tech Coloproctol 2007;10:300–301. DOI: 10.1007/s10151-007-0373-7.
  16. Weaver RM, Ambrose NS, Alexander-Williams J, et al. Manual dilatation of anus vs. Lateral subcutaneous sphincterotomy in the treatment of chronic fissure-in-ano. Results of a prospective, randomized, clinical trial. Dis Colon Rectum 1987;30(6):420–423. DOI: 10.1007/BF02556488.
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