CHRONIC FISSURE IN ANO: 0.25% GLYCERYL TRINITRATE VERSUS LATERAL INTERNAL SPHINCTEROTOMY
Objective: Chronic anal fissure is a painful linear tear at the anal verge distal to dentate line. Different options are available
for its treatment. The objective of this study was to compare topical 0.25% Glyceryl Trinitrate with Lateral internal
sphincterotomy for the treatment of chronic anal fissure in terms of healing, pain relief, complications of the treatment
and recurrence of fissure.
Method: This Prospective Randomized controlled trial was carried out at Naseer Teaching Hospital, Gandhara University,
Peshawar from 1st January 2013 to 31st July 2013. Patients were selected by simple random sampling technique
and divided into Group 1 – Glyceryl trinitrate and Group 2 – Lateral Internal Sphincterotomy. Patients were followed up
at 2, 4, 6 and 12 weeks. Data was analyzed on SPSS 17.
Results: The study included 80 patients; 37 in group 1 and 43 in group 2. Decrease in Visual Analogue Scale (VAS)
pain score of ≥ 45 mm from the baseline was observed in 81.08% in group 1 at 12 weeks. Group 2 had decrease in
VAS score in 86.04% within 48 hrs of surgery and in 97.6% at 12 weeks (p value <0.05). Anal fissure healed in 64.86%
in group 1 and in 97.6% in group 2 (p value <0.05). Headache (62.16%) was the commonest complication in group 1.
Transient gas and liquid incontinence were noted in 4.65% in group 2. Recurrence occured in 32.43% in group 1 and
4.65% in group 2 (p value<0.05).
Conclusion: Lateral internal sphincterotomy is a safe procedure with minimal complications. It allows rapid pain relief
and superior healing compared to Glyceryl trinitrate.
Key Words: Chronic anal fissure, Glyceryl trinitrate, Sphincterotomy.