CHRONIC ANAL FISSURES

TOPICAL GLYCERYL TRINITRATE VERSUS LATERAL INTERNAL SPHINCTEROTOMY

Abstract

Objective: The objective of this study was to compare the topical GTN and
lateral internal sphincterotomy for the treatment of chronic anal fissure. Setting: This was a prospective randomized
cohort study conducted at Isra University Hospital, Hyderabad between September 2004 and August 2005. Material
and Methods: Fifty patients fulfilling the selection criteria were randomly divided into two equal groups. One group was
treated with topical glyceryl trinitrate (GTN) ointment and other group was treated with lateral internal sphincterotomy.
Patients were followed up in outpatients department after regular intervals for about one year. The data was collected
and two groups were compared with special reference to pain relief, fissure healing and recurrence rate. Results: Pain
relief was observed in 96% of the patients in GTN group as compared to 92% of the patients in sphincterotomy group
after 6 weeks. Complete healing of fissure was observed in 92% of the patients in GTN group as compared to 88% of
the patients in sphincterotomy group after 6 weeks. Recurrence was observed in 16% of the patients in GTN group as
compared to 4% of the patients in sphincterotomy group after one year. Conclusion: GTN and lateral internal
sphincterotomy are comparable in terms of pain relief and fissure healing after 6 weeks. Topical GTN is suggested to
be the initial treatment whereas lateral internal sphincterotomy is suggested to be reserved for the patients not
responding to topical GTN or having recurrence after completion of treatment with GTN.