Short-term results of platelet-rich plasma in the treatment of chronic anal fissure: Randomized controlled clinical study

Abstract

Background: Anal fissure is one of the most common benign anal disorders, and medical treatments play an important role in its management.Objective: The purpose of this study was to investigate the short-term effects and success of platelet-rich-plasma in the treatment of chronic anal fissure.Design: The study is a two parallel-group, randomized, controlled clinical trial.Settings: The study was carried out in two tertiary university hospitals.Patients: Forty-four-patients with chronic anal fissure were randomly assigned to platelet-rich-plasma treatment or control group. Presenting symptoms and pain scores were recorded on enrolment. The control patient self-administered topical glyceryl trinitrate. Platelet-rich-plasma was injected locally in the intervention group followed by self-administered glyceryl trinitrate.Main outcome measures: Primary outcome measure is a reduction in pain scores.Results: On day 10 and one month after treatment, the mean pain score was significantly lower in the platelet-rich-plasma patients than in the controls (p=0.005 and p<0.005, respectively). By one month after treatment, mean pain score declined by 5.7 points in the platelet-rich plasma-treated group compared with a 4.1 mean pain score decline in the control group (mean difference:1.6 points [95% confidence interval;0.3-2.9]).According to the repeated-measures analyses, Pain scores decreased in both groups, but the decrease in the treatment group was statistically higher than the control group (p<0.001).Complete epithelialization and recovery rates were significantly higher in the platelet-rich-plasma group than in controls at all follow-up times, with p-values ranging from 0.034 to<0.001.The observed difference in complete epithelialization after two months of treatment between the platelet-rich-plasma group and the control group was 56.2% with a 95% confidence interval of 14.03% to 98.4%.Limitations: This study was limited by its small sample size and long-term follow-up of the patients was not given.Conclusions: Platelet-rich-plasma reduced complaints and accelerated epithelialization and healing in patients with chronic anal fissures.