Randomized clinical trial comparing oral nifedipine with lateral anal sphincterotomy and tailored sphincterotomy in the treatment of chronic anal fissure

Ho, K.-S., and Ho, Y.-H. (2005) Randomized clinical trial comparing oral nifedipine with lateral anal sphincterotomy and tailored sphincterotomy in the treatment of chronic anal fissure. British Journal of Surgery, 92 (4). pp. 403-408.

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Abstract

Background: The conventional treatment of chronic anal fissure is lateral sphincterotomy (LAS). The alternative options of tailored sphincterotomy (TS) and chemical sphincterotomy using medication such as nifedipine have recently become available.

Methods: A prospective randomized trial was conducted to compare LAS with TS and oral nifedipine. The main endpoints were fissure healing, symptom relief, recurrence and continence.

Results: One hundred and thirty-two patients were treated and followed up for 4 months. LAS was significantly more effective than TS in providing pain relief (P = 0·004) and better patient satisfaction (P = 0·020) at 4 weeks. Surgery (LAS and TS) was associated with significantly better fissure healing rates (both P < 0·001 at 16 weeks) and less recurrence (both P = 0·003) than nifedipine. There were substantial problems with compliance in the nifedipine group (17 of 41 patients), related to side-effects and slow healing. There were no differences in continence between the three treatment groups.

Conclusion: LAS was most effective in providing pain relief and allowing rapid fissure healing, with minimal recurrence and no increased risk of incontinence, in patients with good anal sphincter function.

Item ID: 6044
Item Type: Article (Research - C1)
ISSN: 1365-2168
Keywords: bowel disease; incontinence; surgery; treatment, medical
Date Deposited: 01 Apr 2010 01:38
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1103 Clinical Sciences > 110323 Surgery @ 100%
SEO Codes: 92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920118 Surgical Methods and Procedures @ 100%
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