Indian Journal of Surgery

, Volume 80, Issue 6, pp 586–591 | Cite as

Efficacy of New Grading System (MK Grading) for Management of Fissure-in-Ano

  • Madhura KilledarEmail author
  • S. H. Kulkarni
  • Honeypalsinh H. Maharaul
  • Alka Gore
Original Article


Fissure-in-ano is very common and painful ano-rectal condition, usually involving the young productive age group. The majorities of fissures are acute and resolve within 6–8 weeks of conservative treatment, but a significant minority of fissures becomes chronic. Various conservative treatments have been suggested, e.g., high-residue diet, topical nitric oxide (NO)-releasing agents (glyceryl trinitrate [GTN]), botulin toxin injections (Botox), to mention just a few. When conservative treatment fails, the patient is referred for surgery Lund and Scholefield (Br J Surg 83:1335–1344, 1996).

After many years of practice as colo-proctologist, the author has put forth this “new grading system M.K. grading” (initials of Authors) first time in the literature for fissure-in-ano which would be determining factor in the management of such patients. We can thus avoid distressful pain and unnecessary waiting period for the healing of fissure-in-ano with conservative treatment. The author and coauthors have studied the efficacy of this grading system for determining the management of fissure-in-ano. This is the prospective study of patients with fissure-in-ano who presented to surgical outpatient department during the period of 2 years. At the end of study, data was collected and analyzed to know the efficacy about the grading system.


Fissure-in-ano Grades of fissure-in-ano Sphincterotomy Nifedipine with lignocaine 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.


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Copyright information

© Association of Surgeons of India 2017

Authors and Affiliations

  • Madhura Killedar
    • 1
    Email author
  • S. H. Kulkarni
    • 1
  • Honeypalsinh H. Maharaul
    • 1
  • Alka Gore
    • 1
  1. 1.Bharari Vidyapeeth Deemed University Medical College and HospitalSangliIndia

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