A Comparative Outcome of Oral Versus Tropical Calcium Channel Blocker (CCB) For Chronic Anal Fissure Treatment

Authors

  • Samar Memon Department of surgery, Bilawal Medical College for Boys, Liaqat University of Medical & health Sciences
  • Sohail Soomro Department of surgery, Bilawal Medical College for Boys, Liaqat University of Medical & health Sciences
  • Asad Ali Shah Department of surgery, Bilawal Medical College for Boys, Liaqat University of Medical & health Sciences
  • Tufail Ahmed Baloch Department of surgery, Bilawal Medical College for Boys, Liaqat University of Medical & health Sciences

Abstract

Background: Topical pharmacological agent local application is the first line therapy for chronic anal fissure and is recommended along with strong analgesics and sitz bath for at least 6-weeks. Calcium Channel Blockers (diltiazem and nefidipine) are associated with similar efficacy with fewer side effects compared to commonly used GTN (0.2%).
Objective: To review the effectiveness of Oral versus Topical CCB in the treatment of Chronic Anal Fissure (CAF) in respect of healing and pain relief.
Methodology: This was a randomized control study conducted at Department of Surgery District Headquarter Hospital Kotri District Jamshoro Sindh  from 1st November2022 to June 2023. Relevant published articles were searched to formulate our study.
Total calculated sample size was 60 patients, 30 in each group, group A (Oral CCB) group B (Topical CCB). Both genders were diagnosed as a case of chronic anal fissure (CAF) having age ranges between 25-45 years. Patients with co-morbid like hepatitis B & C, cardiovascular diseases and hypersensitivity to calcium channel blockers were excluded from the study.
After taking written Ethical Approval from the Medical superintendent of the concerned Hospital, all the patients filling the selection criteria were included in the study. Inform consent was taken and patients were randomly divided into 2 equal groups A & B. Randomization was done through by lottery method. In group Patients in group A were prescribed tropical Nefidipine(0.2%) application at the anal verge 8-hourly for 4-weeks. Similarly in group B patients were prescribed oral CCB (20mg) 12-hourly for 4-weeks. All patients were encouraged for high fiber diet (green leafy vegetables, salad & fruits) and warm sitz bath for 10 to 15 minutes 2-3 times daily. On each follow up OPD visit wound healing and pain relieve (VAS) is recorded on
proforma. Wound healing was assessed by local inspection of the anal verge by separating the buttocks. Development of granulation tissue and re-epithelization was assessed. Effectiveness was judged by patients' oral feedback in terms of no pain during defecation and patients' satisfaction. All data was entered in a proforma analyzed using SPSS version 22.
Results: 60 patients were enrolled in the study including both genders with a diagnosis of CAF. 30-patients (group A) were given Oral CCB, and other 30- patients were kept on Topical CCB. On random analysis Topical CCB was associated with lower incident of unhealed anal fissure compared to Oral CCB. There was no significant difference in side effects or fissure recurrence.
Conclusion: Topical CCB has better healing and pain-relieving effects with fewer side effects compared to Oral CCB.
Keywords: Chronic Anal fissure, calcium

Published

2024-06-11

Issue

Section

Original Articles