Lateral subcutaneous sphincterotomy for treatment of anal fissure in children

Aims-To determine the eVectiveness and safety of topical glyceryl trinitrate (GTN) in the management of acute anal fissure in children. Methods-Individual children were randomised to receive GTN paste or placebo for six weeks in addition to oral senna and lactulose. Patients took laxatives alone for a further 10 weeks. Each week a research nurse telephoned families to assess pain scores and give advice. Main outcome measures were validated standardised pain scores and time to painless defaecation. Results-Forty subjects were recruited from 46 eligible children; 31 children completed the trial (13 in the GTN group and 18 in the placebo group). No diVerences in the proportion of those achieving pain free defaecation with relation to time were seen between the two groups. Similarly, there were no significant diVerences in pain scores between the two groups over the 16 week study period. However, in both groups pain scores had decreased significantly. There were no diVerences in the incidence of rectal bleeding, faecal soiling, presence of visible fissure, skin tag, or faecal loading at outpatient review at the time of recruitment, or at 6 weeks and 16 weeks. No serious adverse eVects were observed. Conclusions-This study suggests that 0.2% GTN paste is ineVective in the treatment of acute anal fissures in childhood. However the overall fissure healing rate is high (84%) with associated reduction in pain scores, suggesting that a nurse based treatment programme can achieve a high rate of fissure healing. (Arch Dis Child 2001;85:404-407)

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Pharmacological advancements in the treatment of chronic anal fissure

Acheson

Scholefield

2005

Expert Opinion on Pharmacotherapy

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Chronic anal fissure is a tear in the lining of the anal canal that, if not treated appropriately at an early stage, causes considerable anal pain during defaecation. Surgery is no longer considered the first-line treatment of this common condition, as recent advancements in medical treatment has produced promising results in the healing of fissures, thus avoiding the unwanted complications that frequently occur following operative treatment. This review looks at those pharmacological agents used commonly in the treatment of chronic anal fissures and explores alternative therapies that may be of benefit in the future.

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Lateral subcutaneous sphincterotomy for treatment of anal fissure in children

Cited by 3 publications

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The Management of Anal Fissure

The Management of Anal Fissure

Double blind randomised controlled trial of topical glyceryl trinitrate in anal fissure

Pharmacological advancements in the treatment of chronic anal fissure

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