Zinc oxide, lidocaine, and lateral internal sphincterotomy for fissure-in-ano: a comparative study
Keywords:Lateral internal sphincterotomy, Zinc oxide, Anal fissures, Lidocaine treatment
Background: The aim of the study was to choose best method for management of fissure-in-ano. By comparing among zinc oxide pomade, lidocaine pomade and lateral internal sphincterotomy for treatment of anal fissure.
Methods: 90 patients who were diagnosed with anal fissure between 2019 and 2021 at our MGM Medical College and M. Y. Hospital were undertaken for this prospective randomized trial. All cases randomized into three groups. Group 1 were the patients who applied 15% of zinc oxide pomade twice a day. Group 2 were the patients would apply 5% of lidocaine pomade twice a day. Group 3 were those undergone with lateral internal sphincterotomy. Healing rates, pain relief, recurrences, changes in symptoms after the treatment and complications were recorded.
Results: There were no statistical difference among groups in terms of age and gender. The healing and symptomatic relief in the sphincterotomy group significantly much more when compared to the other groups (p=0.05). Recurrence rate is very less in sphincterotomy group.
Conclusions: Lateral internal sphincterotomy is better treatment option when compared to zinc oxide and lidocaine. There was no difference between zinc oxide and lidocaine treatments.
Jonas M, Scholefield JH. Anal Fissure. Gastroenterol Clin North Am. 2001;30(1):167-81.
Wollina U. Pharmacological sphincterotomy for chronic anal fissures by botulinum toxin a. J Cutan Aesthet Surg. 2008;1(2):58-63.
Nelson RL, Thomas K, Morgan J, Jones A. Non surgical therapy for anal fissure. Cochrane Database Syst Rev. 2012;2012(2):3431.
Lansdown ABG. Zinc in the healing wound. Lancet. 1996;347(9003):706-7.
Pories WJ, Henzel JH, Rob CG, Strain WH. Acceleration of wound healing in man with zinc sulphate given by mouth. Lancet. 1967;1(7482):121-4.
Sunzel B, Lasek J, Söderberg T, Elmros T, Hallmans G, Holm S. The effect of zinc oxide on Staphylococcus aureus and polymorphonuclear cells in a tissue cage model. Scand J Plast Reconstr Surg Hand Surg. 1990;24(1):31-5.
Fazio VW, Church JM, Delaney CP. Current therapy in colon and rectal surgery. 2nd ed. US: Elsevier Mosby; 2005:19-22.
Tander B, Güven A, Demirbağ S, Ozkan Y, Oztürk H, Cetinkurşun S. A prospective, randomized, double-blind, placebo-controlled trial of glyceryl-trinitrate ointment in the treatment of children with anal fissure. J Pediatr Surg. 1999;34(12):1810-2.
Ay S, Eryilmaz MA, Oku A, Karahan O. Zinc oxide, lidocaine, hot water, and lateral internal sphincterotomy for fissure-in-ano: randomized controlled study. Annals Med Res. 2019;26(3):355-9.
Stewart DB, Gaertner W, Glasgow S, Migaly J, Feingold D, Steele SR. Clinical practice guideline for the management of anal fissures. Dis Colon Rectum. 2017;60(1):7-14.
Brown CJ, Dubreuil D, Santoro L, Liu M, O'Connor BI, McLeod RS. Lateral internal sphincterotomy is superior to topical nitroglycerin for healing chronic anal fissure and does not compromise long-term fecal continence: six-year follow-up of a multicenter, randomized, controlled trial. Dis Colon Rectum. 2007;50(4):442-8.
Acheson AG, Scholefield JH. Anal fissure: the changing management of a surgical condition. Langenbecks Arch Surg. 2005;390(1):1-7.
Cevik M, Boleken ME, Koruk I, Ocal S, Balcioglu ME, Aydinoglu A, et al. A prospective, randomized, double-blind study comparing the efficacy of diltiazem, glyceryl trinitrate, and lidocaine for the treatment of anal fissure in children. Pediatr Surg Int. 2012;28(4):411-6.
Ho KS, Ho YH. Randomized clinical trial comparing oral nifedipine with lateral anal sphincterotomy and tailored sphincterotomy in the treatment of chronic anal fissure. Br J Surg. 2005;92(4):403-8.
Orsay C, Rakinic J, Perry WB, Hyman N, Buie D, Cataldo P, et al. Practice parameters fort he management of anal fissures (revised). Dis Colon Rectum. 2004;47(12):2003-7.
Lindsey I, Jones OM, Cunningham C, Mortensen NJ. Chronic anal fissure. Br J Surg. 2004;91(3):270-9.
Nivatvongs S. Division of Colon and Rectal Surgery. In: Kelly AK. Sarr GM, Hinder AR, eds. Mayo Clinic gastrointestinal surgery. 1st ed. Finland: Saunders; 2004: 589-626.
Kocher HM, Steward M, Leather AJ, Cullen PT. Randomized clinical trial assessing the side-effects of glyceryl trinitrate and diltiazem hydrochloride in the treatment of chronic anal fissure. Br J Surg. 2002;89(4):413-7.
Ersan Y, Kuşaslan R. Anal fissürlerde medikal tedavi. Cerrahpaşa. J Med. 2004;35:194-9.
Tranqui P, Trottier DC, Victor C, Freeman JB. Nonsurgical treatment of chronic anal fissure: nitroglycerin and dilatation versus nifedipine and botulinum toxin. Can J Surg. 2006;49(1):41-5.
Thornton MJ, Kennedy ML, King DW. Manometric effect of topical glyceryl trinitrate and its impact on chronic anal fissure healing. Dis Colon Rectum. 2005;48(6):1207-12.
Chaurasia’s BD. Human Anatomy. 4th ed. India: CBS Publishers; 2020.
Zinner M, Ashely S. Maingot's Abdominal Operations. 11th ed. New York, NY: McGraw-Hill; 2006.
Floyd ND, Kondylis L, Kondylis PD, Reilly JC. Chronic anal fissure: 1994 and a decade later are we doing better? Am J Surg. 2006;191(3):344-8.
Way LW, Doherty GM. Current Surgical Diagnosis and treatment. 11th ed. New York, NY: McGraw-Hill; 2002.