Advertisement

Indian Journal of Surgery

, Volume 80, Issue 6, pp 586–591 | Cite as

Efficacy of New Grading System (MK Grading) for Management of Fissure-in-Ano

  • Madhura KilledarEmail author
  • S. H. Kulkarni
  • Honeypalsinh H. Maharaul
  • Alka Gore
Original Article

Abstract

Fissure-in-ano is very common and painful ano-rectal condition, usually involving the young productive age group. The majorities of fissures are acute and resolve within 6–8 weeks of conservative treatment, but a significant minority of fissures becomes chronic. Various conservative treatments have been suggested, e.g., high-residue diet, topical nitric oxide (NO)-releasing agents (glyceryl trinitrate [GTN]), botulin toxin injections (Botox), to mention just a few. When conservative treatment fails, the patient is referred for surgery Lund and Scholefield (Br J Surg 83:1335–1344, 1996).

After many years of practice as colo-proctologist, the author has put forth this “new grading system M.K. grading” (initials of Authors) first time in the literature for fissure-in-ano which would be determining factor in the management of such patients. We can thus avoid distressful pain and unnecessary waiting period for the healing of fissure-in-ano with conservative treatment. The author and coauthors have studied the efficacy of this grading system for determining the management of fissure-in-ano. This is the prospective study of patients with fissure-in-ano who presented to surgical outpatient department during the period of 2 years. At the end of study, data was collected and analyzed to know the efficacy about the grading system.

Keywords

Fissure-in-ano Grades of fissure-in-ano Sphincterotomy Nifedipine with lignocaine 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Lund JN, Scholefield JH (1996) The aetiology and treatment of anal fissures. Br J Surg 83:1335–1344CrossRefGoogle Scholar
  2. 2.
    Jensen SL (1988) Diet and other risk factors for fissure-in-ano. Prospective case control study. Dis Colon rectum 31(10):770–773CrossRefGoogle Scholar
  3. 3.
    Schouten WR, Briel JW, Auwerda JJ, Boerma MO (1996) Anal fissure: new concepts in pathogenesis and treatment. Scand-J-Gastroentero- suppl 218:78–81CrossRefGoogle Scholar
  4. 4.
    Jensen SL (1986) Treatment of first episode of acute anal fissure—a prospective, randomized study of lignocaine ointment vs. hydrocortisone ointment vs. warm sitz bath plus bran. BMJ 292(6529):1167–1169CrossRefGoogle Scholar
  5. 5.
    Bhardwaj R, Drye E, Vaizey C (2006) Novel delivery of botulinum toxin for the treatment of anal fissures. Colorect Dis 8:360–364CrossRefGoogle Scholar
  6. 6.
    Cook TA, Humphreys MM, McC Mortensen NJ (1999) Oral nifedipine reduces resting anal pressure and heals chronic anal fissure. Br J Surg 86(10):1269–1273CrossRefGoogle Scholar
  7. 7.
    Lund JN, Scholefield JH (1997) Glyceryl trinitrate is an effective treatment for anal fissure. Dis-Colon-rectum 40(4):468–470CrossRefGoogle Scholar
  8. 8.
    Libertiny G, Knight JS, Farour R (2002) Randomized trial of topical 0.2% glyceryltrinitrate and lateral internal sphincterotomy for the treatment of patients with chronic and fissure: long-term follow-up. Eur J Surg 168:418–421CrossRefGoogle Scholar
  9. 9.
    Knight JS, Birks M, Farouk R (2001) Topical diltiazem ointment in the treatment of chronic anal fissure. Br J Surg 88(4):553–556CrossRefGoogle Scholar
  10. 10.
    Bielecki K, Kolodziejczak MA (2003) Prospective randomized trial of diltiazem and glyceryltrinitrate ointment in the treatment of chronic anal fissure. Color Dis 5(3):256–257CrossRefGoogle Scholar
  11. 11.
    Saad AM, Omer A (1992) Surgical treatment of chronic fissure-in-ano: a prospective randomised study. East Afr Med J 69(11):613–615Google Scholar
  12. 12.
    Nelson R (2002) Operative procedures for fissure-in-ano. Cochrane Database Syst Rev 1:CD002199Google Scholar
  13. 13.
    Pelta AE, Davis KG, Armstrong DN (2007) Subcutaneous fissurotomy: a novel procedure for chronic fissure-in-ano. A review of 109 cases. Dis Colon rectum 50:1662–1667CrossRefGoogle Scholar
  14. 14.
    Al-Raymoony AE (2001) Surgical treatment of anal fissures under local anesthesia. Saudi Med J 22(2):114–116Google Scholar
  15. 15.
    Pernikoff BJ, Eisenstat TE, Rubin RJ et al (1994) Reappraisal of partial lateral internal sphincterotomy. Dis Colon rectum 37:1291–1295CrossRefGoogle Scholar
  16. 16.
    Yucel T, Gonullu D, Oncu M, Koksoy FN, Ozkan SG, Aycan O (2009) Comparison of controlled-intermittent anal dilatation and lateral internal sphincterotomy in the treatment of chronic anal fissures: a prospective, randomized study. Int J Surg 7:228–231CrossRefGoogle Scholar
  17. 17.
    Garner JP, McFall M, Edwards DP (2002) The medical and surgical management of chronic anal fissure. J R Army Med Corps 148:230–235CrossRefGoogle Scholar
  18. 18.
    Thomson JPS, Nicholls RJ, Williams CB(1981) Anal fissure in colorectal diseases. London: William Heinemann Medical Book Limited. p. 312Google Scholar
  19. 19.
    Gupta PJ (2004) Treatment of fissure in ano-revisited. African Health Sci 4(1):58–62Google Scholar

Copyright information

© Association of Surgeons of India 2017

Authors and Affiliations

  • Madhura Killedar
    • 1
    Email author
  • S. H. Kulkarni
    • 1
  • Honeypalsinh H. Maharaul
    • 1
  • Alka Gore
    • 1
  1. 1.Bharari Vidyapeeth Deemed University Medical College and HospitalSangliIndia

Personalised recommendations