Apamarga Ksharasutra application and open lateral internal sphincterotomy in the management of Parikartika (chronic fissure‑in‑ano): A randomized controlled clinical trial.

Introduction: Parikartika resembles fissure‑in‑ano which is one of the common painful disease among the anorectal disorders. Ksharasutra which is a para‑surgical procedure is effective in the management of Parikartika.

Aim: To compare the efficacy of Apamarga Ksharasutra and open lateral internal sphincterotomy (OLIS) in the management of Parikartika (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 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 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 ligation in the management of Parikartika (chronic fissure‑in‑ano).