COMPARISON OF ROLE OF TOPICAL GLYCERYL TRINITRATE OINTMENT VERSUS LATERAL INTERNAL SPHINCTEROTOMY FOR CHRONIC ANAL FISSURE

ABSTRACT
Background: Anal fissure is one of the most common distressing disorders in ano-rectal region. Symptoms from anal
fissure cause considerable morbidity and reduction in quality of life. Typically it causes symptoms of severe pain after
defecation and bright red rectal bleeding.
Objective: This study aimed to determine the effectiveness of glyceryl trinitrate(GTN) versus lateral internal sphincterotomy
in treatment of chronic anal fissure.
Material and Methods: This prospective randomized controlled study was conducted at Hayatabad Medical Complex
Peshawar between may 2008 to may 2009 after approval from hospital ethical and research committee. Seventy patients
with chronic anal fissure were divided into two equal groups. Group A (35 patients) were treated with topical glyceryl
trinitrate ointment (0.2%) three times dialy and Group B (35 patients) were subjected to lateral internal sphincterotomy.
All patients were followed up in the out- patient department at two weeks intervals for eight weeks to evaluate the improvement
in symptoms and efficacy of procedures.
Results: Pain relief was noticed in 60% patients in group A versus 80% in group B after four weeks, and 80% in group
A and 90% in group B after eight weeks of follow up. Complete fissure healing occurred in 74% and 85% 0f group A
and group B patients respectively after eight weeks follow up.
Conclusion: Application of GTN ointment as a local treatment for chronic anal fissure should be considered first line
treatment because it is safe, easily handled , cost effective , reversible ,heals about 70% of chronic anal fissures and
avoids complications of surgery. Lateral internal sphincterotomy was superior in terms of healing, but it is an invasive
procedure and therefore should be reserved for patients not responded to topical GTN theraphy .
Key words: Chronic anal fissure, GTN ointment (0.2%), lateral internal sphincterotomy (LIS) .