GTN ointment in the treatment of anal fissures: audit of local experience in Mubarak Al-Kabeer Hospital, Kuwait

ABSTRACT

To evaluate the role of topical glyceryl trinitrate [GTN] ointment as a non-surgical treatment for anal fissure. Anal fissure is an ischemic disease caused by spasm of internal anal sphincter. Nitric oxide from GTN causes chemical sphincterotomy and improves blood flow, thus healing the anal fissure. Prospective study conducted from May 2003 to April 2004. Surgical outpatient clinic, Department of Surgery, Mubarak Al-Kabeer Hospital, Kuwait. Eighty-six patients [42 male and 44 female] were recruited. Thirty seven patients had acute and 49 had chronic anal fissure. All patients were treated with topical 0.2% GTN ointment twice daily with additional application after defecation. An independent observer assessed the patients until full healing of fissures. Patient compliance was good. One patient developed transient mild headache. All patients achieved great reduction in pain score from a mean of 5.3 pre-treatment to 0.92 after one week and nearly zero at 4-6 weeks' treatment. Complete healing occurred at four weeks in all cases from the acute anal fissure group [100%] and in 37 patients [75.5%] from the chronic anal fissure group. Twelve [24.4%] unsuccessful patients with chronic anal fissure underwent surgical sphincterotomy. Recurrence occurred at two months in three patients [8.1%] with acute anal fissure requiring another course of GTN ointment, and in one patient [2.04%] with chronic anal fissure who required surgery. GTN ointment for anal fissure should be considered as a first line treatment prior to surgical intervention in order to reduce complications of surgery