Indian Journal of Surgery

, Volume 81, Issue 1, pp 101–101 | Cite as

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

  • Varun ArunagiriEmail author
  • Kothai Anbalagan
Letter to Editor

Dear Sir,

After analyzing the statistics of the article ‘Efficacy of New Grading System (MK Grading) for Management of Fissure-in-Ano’ which appeared online on 29th October 2017, I was unhappy with the results of the statistics described. [1] The Chi-Square test which has been used in the statistical analysis to obtain the P value of 0.000 had no mention on which variables it had been applied for. Moreover, the P value is always from 0 to 1 and can never be zero. If it is zero, there are multiple explanatory variables used for the test.

The grading system mentioned in the article is based on anatomical appearance of the Fissure. But the treatment of the Fissure is based on the symptoms of the Fissure in Ano. Asymptomatic Fissure in Ano goes unnoticed and patient presents to the surgeons’ office only if they are symptomatic. The Cochrane systematic review advises surgery for the patients not responding to medical management both for acute and chronic Fissure in Ano. [2]

There is a typo error ‘post-defection pain’ which needs to be corrected as ‘post defecation pain’ as the whole meaning of the sentence gets changed.


Compliance with Ethical Standards

Conflicts of Interest

The authors declare that they have no conflict of interest.


  1. 1.
    Killedar M, Kulkarni SH, Maharaul HH, Gore A (2017) Efficacy of New Grading System (MK Grading) for Management of Fissure-in-Ano. Indian J Surg.
  2. 2.
    Nelson RL, Chattopadhyay A, Brooks W, Platt I, Paavana T, Earl S, Cochrane Colorectal Cancer Group (2011) Operative procedures for fissure in ano. Cochrane Database Syst Rev 11.

Copyright information

© Association of Surgeons of India 2018

Authors and Affiliations

  1. 1.Mediheal Group of HospitalsNairobiKenya
  2. 2.Chennai CorporationChennaiIndia

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