Abdul Qadeer, Abdul Karim Siddiqui.
Cryosurgery in chronic Fissure-in-ano; a clinical trial.
J Surg Pak Jan ;10(4):51-2.

Objective: To determine the effectiveness and safety of cryosurgery as an out-patient, minimally-invasive modality of treatment for chronic fissure-in-ano. Design: Observational study. Place & Duration Of Study: At Ankelseria Nursing Home, Karachi, from July I999 to June 2003. Patients and Methods: Male patients of various age groups having chronic fissure-in-ano were treated. Basco and Spembly cryosurgical instruments and nitrous oxide gas were used. Probe was passed through proctoscope and applied to anal papilla, upper 1/3rd, middle 1/3rd, lower 1/3rd and skin tag in sequence for 11/2 to 2 minutes. Local anesthetics were used in selected cases having severe pain after the procedure. Results: Out of 11 cases, cryosurgery failed in 3 patients (27.27%) because they had severe pain and underwent operation within 3 days. Eight patients (72.72%) responded well to the treatment. Pain relief was 50% in 5 patients after 2 weeks; while after 4 weeks 4 had 50% relief and 7 had 75% relief After 8 weeks all 8 were free of pain. After 8 weeks ulcer was completely healed in 6 and partially healed in 2 cases. Anal papilla was eradicated completely in 3 and partially in 2. Skin tags completely disappeared in 3 and had no effect in 2 patients. Followup for 6 months showed complete pain relief and ulcer healing in all, except 3 cases. Conclusion: Cryosurgery is simple, safe, minimally invasive and effective modality of treatment for chronic fissure-in-ano.

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