Afsheen Zafar, Ahmed Rehman, Mohammad Iqbal Khan.
Chronic anal fissures - association with sentinel skin tag.
Rawal Med J Jan ;35(2):177-9.

Objective: To compare characteristics of the chronic fissures which healed with pharmacological agents with those which ultimately required sphincterotomy. Methods: This cross sectional comparative study was performed on 180 patients who presented with chronic anal fissure. Out of them, 31 patients underwent lateral internal sphincterotomy (LIS) due to non-healing or recurrence despite at least 6 weeks therapy of 0.2% Glyceryl trinitrate (GTN) ointment. The frequency of multiplicity and any association with skin tags or hemorrhoids was noted in two groups using chi-square test for statistical analysis. Results: Out of 180 patients, 149(82.8%) healed with GTN ointment, 31(17.2%) underwent LIS. 39(21.7%) patients had associated skin tag, 23(12.8%) had hemorrhoids and 12(6.7%) had multiple fissures. There was significant association of skin tags with fissures undergoing LIS (p < 0.001). Conclusions: Association with a sentinel skin tag is a predictor of failure of medical treatment for chronic anal fissure. (Rawal Med J 2010;35:177-179).

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