Does the duration of symptoms of anal fissure impact its response to conservative treatment? A prospective cohort study. (August 2017) - Emile, Sameh Hany
Abstract: Background: Conservative treatment is the first line of treatment for anal fissure. The current study aimed to evaluate the impact of symptom duration on the response of anal fissure to conservative treatment. Patients and methods: This prospective study was conducted on sixty patients with acute or chronic anal fissure who were treated conservatively with bulking agents, Sitz baths, and topical glyceryl trinitrate (GTN) 0.2%. Pain and constipation were assessed prior to treatment and at 6 weeks after therapy using visual analogue scale (VAS) and Wexner constipation score. Adverse effects as headache and postural hypotension were also queried. Results: The mean pre-treatment VAS for acute fissure was significantly higher than chronic fissure (8.8 ± 0.96 Vs 5.8 ± 1.12), also the post-treatment VAS for acute fissure was significantly lower at 6 weeks of treatment (0.47 ± 0.8 Vs 2.5 ± 1.3). The baseline Wexner constipation score was comparable in both groups; however, at six weeks of treatment it declined more significantly in patients with acute fissure. Patients with acute fissure achieved significantly better healing than chronic fissure (80% Vs 40%). Healing rates decreased from 100% in patients with symptoms < one month to 33.3% in patients with symptoms >6 months. Conclusion: Conservative treatment including topical GTN 0.2% significantly hastened healing and relieved pain and other symptoms of acute more than chronic anal fissure. Healing rates of anal fissure in response to conservative treatment showed remarkable decrease in proportion to the duration of complaint. Highlights: 60 patients with anal fissure were treated conservatively and were evaluated at 6 weeks. Mean pre-treatment VAS for acute fissure was significantly higher than chronic fissure. Post-treatment VAS for acute fissure was significantly lower at 6 weeks. Patients with acute fissure achieved significantly better healing than chronic fissure. Healing declined from 100% when symptoms were < one month to 33.3% when symptoms >6 months.