Chemical sphincterotomy versus surgical lateral sphincterotomy in the treatment of acute and chronic anal fissures

ABSTRACT

Anal fissure is a common condition that causes severe anal pain after defecation causing considerable morbidity and reduction in quality of life. The aim of this study was to evaluate the effectiveness of glyceryl trinitrate [GTN] 0.2% in the treatment of anal fissure and compare it with surgical lateral internal sphincterotomy. From November 2001 to April 2002, 40 patients were selected and divided into two groups Group I treated by GTN [0.2%] and group II with surgical lateral sphincterotomy. Group I patients showed reduction of anal pain in 95% [9/10 acute and 4/10 chronic] with only one failure of treatment due to severe headache, 23% relapse rate after six months. Group II patients had reduction of pain in 100%, healing in 100% of cases and no relapse after six months follow up. It was concluded that internal lateral sphincterotomy is still the gold standard treatment, but GTN can be an alternative to internal lateral sphincterotomy, especially in acute anal fissures