SUMMARY

               The research study entitled “A comparative clinical study of Apamarg Ksharasootra and Lateral Internal Sphincterotomy in the management of Parikartika (Chronic Fissure-In-Ano)- An open randomized Trial. ” Aim and Objective of this study was to compare Apamarga Ksharasootra application and Lateral Internal Sphincterotomy in the management of Parikartika (Chronic Fissure-in-ano). This trial is summarized in Literature review, Ayurvedic literature & Modern literature of Parikartika (Chronic Fissure in ano). For this trial Null hypothesis (H0) was the effect of Apamarga Ksharasootra and open lateral internal sphincterotomy  in the management of Parikartika (Chronic fissure in ano) will be same. Alternative hypothesis (H1) was the effect of Apamarg Ksharasootra application and Latral Inernal Sphincterotomy in the management of Parikartika (Chronic fissure in ano) will not be same. Drug review included description of Apamarga Kshara and Ksharasootra Preparation, SOP of Kshara preparation and their ingredients detail with their properties and mode of action were discussed with classical references. Adjuvant drugs was given in both groups were also discussed with their probable mode of action.

Total 105 patients of Parikartika (Chronic Fissure in Ano) were selected & randomly divided by computerized randomized table. In Group A (n=52) patients treated with trial Ksharasootra application with maximum possible anal dilatation was done while in group-B (n=53) Lateral Internal Sphincterotomy (LIS) was done under LA. or S.A. Jatyadi Taila Matra Basti, Panchawalkala Kwatha for Avagaha Swedana, Erandbhrishta Haritaki orally for laxative were used in post-operative period as adjuvant drugs in both groups. Before treatment, routine hematological, biochemical, urine examination were carried out. The assessment was made on the basis of relief in pain, oozing and days required for complete wound healing after operation. In this study, assessment was done on 7th day, 14th day, 21st day and on 30th post-operative day and Follow up was taken after 1 month. The observed results in the study were subjected to statistical calculation to derive final conclusion.

The discussion was made on all demographic observations and clinical findings i.e. In group-A average 11.75 days required for relief in pain in ano while in group-B average 09.84 days required for relief in pain in ano, which shows the patients of Group-B got relief in pain earlier than patients of Group-A. In this study, it was observed that 92.16% patients got relief in post-operative oozing of blood till 1st week in group-A, 100% patients got relief in P/R bleeding within 14th days in group-A and 89.26% patients got relief in P/R bleeding within 7th days in group-B. This means after Sphincterotomy more days required for stoppage of oozing of blood. It was observed that 50.00% patients got relief in post-operative swelling till 1st  week in group-A, 100% patients got relief in post-operative swelling within 14th  days in group-A and 33.33% patients got relief in post-operative swelling within 7th days in group-B and 100% patients got relief in post-operative swelling within 14th days. Vibandha (Constipation) was relieved in 49 patients of Group-A and 48 patients of Group-B have constipated bowel (Vibandha) which  was relieved within 7 days. In 83.50% patients of Group A and 16.49% of patients of Group B needed other laxative drug for relief in constipation after operation.

Conclusion- In both groups highly significant results were found statistically but early relief in post-operative pain were observed in Group-B (Lateral Internal Sphincterotomy with excision of skin tag) whereas early relief in post-operative swelling and oozing were observed in Group-A (Ksharasootra application with maximum possible anal dilatation). 

Hence Null hypothesis (H0) is rejected and Alternative hypothesis (H1) is accepted i.e. a significant effect of Apamarg Ksharasootra application in the management of Fissure in ano.