Nimba Ksharsutra Application And Open Lateral Internal Sphincterotomy In The Management Of Parikartika W.S.R To Chronic Fissure In Ano

Abstract

Introduction: Parikartika resembles fissure-in-ano. The literal meaning of the term Parikartika i.e. Kartanavat  Vedana (Cutting type of pain) and Guda vidara i.e Vidarana in guda pradesha (Ulceration in Anal canal) are  supportive to this comparison which is very common among all anorectal disorders. Ksharasutra (medicated  caustic thread) was proved successful in the management of fistula-in-ano, piles and there is need to try its  efficacy in Parikartika. Aim: To compare the efficacy of Nimba Ksharasutra (medicated caustic thread) and open lateral internal  sphincterotomy (OLIS) in the management of Parikartika w.s.r to chronic fissure-in-ano. Materials and Methods: Total 30 patients having signs and symptoms of Parikartika (chronic fissure-in-ano)  were selected and randomly divided into two groups. In Group A (n = 15), Ksharasutra (medicated caustic  thread) ligation after anal stretching was carried out while in Group B (n = 15), OLIS with excision of skin tag  was carried out under local anesthesia or spinal anesthesia. Relief in postoperative symptoms and complications  if any was recorded for 4 weeks and follow-up was done for the period of 1 month. Results: In both the groups, significant results were obtained, but the difference among groups was statistically  insignificant. Duration required for relief in postoperative symptoms like pain, bleeding, swelling, and wound  healing was found to be more in Group A (Ksharasutra) than Group B (OLIS). Conclusion: OLIS provided better results compared to Ksharasutra (medicated caustic thread) ligation in the  management of Parikartika w.s.r to chronic fissure-in-ano.