الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Benign anorectal conditions involve hemorrhoids, anal fissures, anal fistulae. These are common problems affecting the population. These conditions commonly require surgery for cure. Postoperative pain is recognized as the most significant problem after conventional surgery for benign anorectal conditions. There are many method developed to treat the postoperative pain like: glyceryl trinitrate (GTN) cream, calcium channel blockers, botox injection, bupivacaine, sucralfate solution, even acupuncture and metronidazole. Metronidazole is postulated to reduce pain by two mechanisms: one being decreasing secondary bacterial colonization or infection, and hence reduction of post-operative inflammation and oedema that causes pain; the other via a direct anti-inflammatory response. Topical metronidazole application has the advantages of improved bioavailability and avoidance of potential systemic side effects. The present study aimed to assess the analgesic effect of topical metronidazole application after surgery for benign anorectal conditions in comparison to oral metronidazole. This clinical study trial was conducted during the period from January 2020 to December 2020. It Included 108 patients with benign anorectal conditions. This study was conducted at Colorectal Surgery Unit, Department of General Surgery, Mansoura University Hospitals. This study was ethically approved from Institutional Review Board (IRB) of Mansoura University Faculty of Medicine, under the code number: MS/19.12.980 and a parental consent from every case or their caregivers that participates in this research was taken. Patients deemed eligible for inclusion to the study were adult patients of either sex aged below 70 years who underwent surgery for hemorrhoids, anal fissure, or simple anal fistula. We excluded patients with grade I-II hemorrhoids, acute anal fissure, complex anal fistula, perianal abscess, perianal Crohn’s disease, or malignancy. Cases were divided into three groups randomly selected: group A cases was received topical application of metronidazole cream on the anal verge after surgery; group B cases was received oral metronidazole after surgery; group C cases was control group. All patients were assessed preoperatively by taking a detailed history of the current complaint, its duration, symptoms, associated medical conditions, previous surgical operations. Physical examination followed and included inspection of the anal verge and digital rectal examination. The continence state was assessed preoperatively by the Wexner incontinence score. Patients consumed clear fluids fluid in the day before surgery and bowel preparation was not routinely done. Surgical procedure • After explaining the nature of the study and the potential benefits and harms, informed consent was obtained from all patients. • All surgical procedures were performed under spinal anesthesia with patients placed in the lithotomy position. • Patients with simple anal fistula underwent Standard lay open fistulotomy. • Patients with hemorrhoids had Milligan-Morgan hemorrhoidectomy. Patients with chronic anal fissure had open lateral sphincterotomy. Outcome measures The primary outcome was pain score on post-operative days 1, 2, and 7 days after anal surgery in the three groups. Secondary outcome parameters included the analgesic requirements, wound healing, return to work, and complications. This study showed that: • Visual analogue scale (VAS) by the end of the study was not significant in pain scores between the three groups at first defecation and at the first day postoperatively. • Visual analogue scale (VAS) by the end of the study was significantly lower in the topical metronidazole group than the oral metronidazole and control groups at the second and the seventh postoperative days. • The analgesic requirements by the end of the study was significantly lower in in the topical metronidazole group than the oral metronidazole and control groups. • Wound healing was significantly better in the topical metronidazole group than the other two groups. • Time to return to work was significantly shorter in the topical metronidazole group than the oral metronidazole group and control group. Conclusion: The study concluded that mean pain score after topical metronidazole cream was less than oral metronidazole tablet in post anorectal surgery patient. The wound healing after use of topical metronidazole cream was better than oral metronidazole in post anorectal surgery patient. The application of metronidazole cream is associated with lower analgesic requirement and the return to normal activity.