Comparison of glyceryl trinitrate (GTN) 0.2% with lateral anal sphincterotomy in the management of chronic anal fissure.

Abstract

Objective: Fissure in ano is a very painful and bothersome condition. The injury occurs while defecating hard stool or stool having hypertonicity causing pain around anal region sometimes with bleeding is the first feature of anal fissure. Study Design: Randomized Control Trial. Setting: Department of Surgery, Gujranwala Medical College and Teaching Hospital, Gujranwala. Period: August 2021 to January 2022. Methods: Sixty (60) patients with age 20 to 60 were included in the study. These were equally distributed randomly into two groups. 1st group underwent lateral anal sphincterotomy and second group receive 0.2% GTN for chronic anal fissure. All these patients were assessed 6 weeks after the start of treatment and were on the basis of control of symptoms per rectum bleed, constipation and pain around perianal region. Results: A total of 60 patients were enrolled and evenly divided into two groups. After 6 weeks of treatment, 90% of patients in the lateral sphincterotomy group achieved complete healing, compared to 50% in the GTN ointment group. Post-treatment perianal pain persisted in only 10% of the surgical group versus 50% in the GTN group. Similarly, per rectal bleeding and constipation were significantly lower in the sphincterotomy group (6.7% each) compared to the GTN group (30% and 46.7%, respectively). The differences between groups were statistically significant (p < 0.05) across all outcome variables. Conclusion: Lateral anal sphincterotomy is significantly more effective than 0.2% glyceryl trinitrate ointment in the treatment of chronic anal fissure. It provides higher healing rates and better symptomatic relief with minimal residual symptoms. Therefore, it should be considered the treatment of choice, especially in patients who do not respond adequately to conservative management.