Vol. 5, Issue 11 (2016)

Author(s):
Dr. Luai Farhan Zghair

Abstract:
Results: Seventy patients were studied, 40 female (57.14%) and 30 male (42.86%) and female to male ratio was 1.33: 1, the age ranged from 1 to 70 years, with a mean age of 29 years + 5 years, the majority being in the 3^th decade of life constituting 20 patients (28.57%). Also our study showed that the causes of the fissure in ANO are chronic constipation and passing hard stool 45 patients (64.28%), the next was post haemorrhoidectomy 10 patients (14.28%), followed by post traumatic (post-delivery) 8 patients (11.43%), diarrhea 6 patients (8.57%) and anal sexual intercourse 1 patients (1.43%). Within 5 days, the fissure related pain was resolved in all patients. At 4 weeks the anal fissure was completely healed in 40 patients (57.14%) and at 6 weeks another 15 patients (21.43%), and at 8 weeks the anal fissure was completely healed in another 5 patients (7.14%). Six patients (8.57%) developed perianal abscess so that anal dilatation and drainage of abscess were done to them under general anaesthesia. Four patients (5.71%) not respond to treatment and lateral sphincterotomy were done to all under general anaesthesia. Conclusion: In our study, fissure healing was found in 85.71% of the cases who received topical diltiazem. The pain relief was satisfactory in a majority of the cases. Headache and perianal itching were the two common side effects which were reported by some of our subjects. However, they were mild and tolerable. One of the drawbacks which were observed was the patient compliance, as the duration of the treatment was quite long i.e. 8 weeks. We conclude that 2% topical diltiazem is quite effective in the treatment of acute fissure in ANO. It may be considered as a first line treatment for acute fissure in ANO. When this fails or fissures recur, anal dilatation or lateral subcutaneous internal sphincterotomy under local or spinal or general anesthesia should be the preferred options for the treatment of fissure in ANO. Nevertheless, all the option should be presented to the patient with complete information about the method, cure rates, complications, and recurrence of the disease.