Chronic Anal Fissures

Abstract

Objective: The objective of this study was to compare the topical GTN andlateral internal sphincterotomy for the treatment of chronic anal fissure. Setting: This was a prospective randomizedcohort study conducted at Isra University Hospital, Hyderabad between September 2004 and August 2005. Materialand Methods: Fifty patients fulfilling the selection criteria were randomly divided into two equal groups. One group wastreated 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 collectedand two groups were compared with special reference to pain relief, fissure healing and recurrence rate. Results: Painrelief was observed in 96% of the patients in GTN group as compared to 92% of the patients in sphincterotomy groupafter 6 weeks. Complete healing of fissure was observed in 92% of the patients in GTN group as compared to 88% ofthe patients in sphincterotomy group after 6 weeks. Recurrence was observed in 16% of the patients in GTN group ascompared to 4% of the patients in sphincterotomy group after one year. Conclusion: GTN and lateral internalsphincterotomy are comparable in terms of pain relief and fissure healing after 6 weeks. Topical GTN is suggested tobe the initial treatment whereas lateral internal sphincterotomy is suggested to be reserved for the patients notresponding to topical GTN or having recurrence after completion of treatment with GTN.