Management of Acute Anal Fissure at a Tertiary Care Hospital in West Bengal, India- A Longitudinal Study

Introduction: Anal fissure is a tear in the lining of the anus and is a common problem throughout the world. It is one of the most common painful and benign conditions of the anal region, which leads to morbidity and decrease in quality of life.

Aim: To prospectively observe the outcomes of management of acute anal fissure, both surgically and conservative modalities of treatment.

Materials and Methods: This longitudinal study constituted patients clinically presenting with features of acute anal fissure such as pain, bleeding, constipation attending Out Patient Department (OPD) in College of Medicine and JNM Hospital, West Bengal, India, from January 2020 to June 2021. Patients were grouped according to modalities of treatment given (surgical/conservative), after that regular follow-up was done at regular intervals to find out outcome of treatment, with respect to relief of pain, bleeding, healing rate, fissure relapse and incontinence. Chi-square test was used to compare the proportions and independent t-test was used to compare means. The p-value of <0.05 was considered to be statistically significant. All the analysis was done in IBM Statistical Package for the Social Sciences (SPSS) version 22.0.

Results: In the current study, 9 (8.8%) patients had anterior anal fissure and 93 (91.2%) patients had posterior anal fissure. Fifty one patients (50.0%) underwent medical management {(nifedipine 2% gel locally, diltiazem (2%) locally)} and 51 patients (50.0%) were treated with surgical management (lateral internal sphincterectomy). Significant difference was noted at 15th, and 30th and 45th days post-treatment when surgically managed patients were compared with medically managed patients p-value <0.05*. Four patients in the medically managed group, had bleeding during the entire period. Association of Bleeding at 15th day, 30th day, 45th day and 6th month with mode of management was statistically significant (p<0.05*) healing was achieved for 90 patients (88.2%) at the end of 6th month follow-up. In medical management, 9 (17.6%) patients had fissure relapse. In surgical management, 3 (5.9%) patients had fissure relapse p>0.05.

Conclusion: In the present study, though patients in both surgical and medical groups had pain relief, those who underwent surgery had better result. Majority of the patients in the study achieved remission, at the end of sixth month follow-up, irrespective of the type of management. Relapse of the disease was slightly more in medically managed group, compared to those, who underwent surgical management.