Tropical 0.2% glyceryl trinitrate ointment versus lateral sphincterotomy in the treatment of acute anal fissure

ABSTRACT

To compare the effectiveness of 0.2%GTN with lateral sphincterotomy in the treatment of acute anal fissure and to asses the complications in the two groups. A Quasi experimental study. The study was conducted at Surgical Unit II, Services Hospital Services Institute of Medical Sciences Lahore during Jan 2002 to Dec. 2004. Eighty patients with acute anal fissure confirmed on history and clinical examination were included in the study. Forty patients were randomized in each group using simple random tables. Group A patients were prescribed 0.2% glyceryl trinitrate ointment to apply intra-anally four times a day for eight weeks and group B patients were admitted in ward and underwent lateral internal sphincterotomy by open technique. Comparison of the two treatments to determine the efficacy and to assess the complications was done. Patients were followed up at one week, two weeks, one month, and final follow was done after two months. In group A [0.2%GTN ointment], thirty eight patients completed treatment for eight weeks. Of these 31[81.6%] patients had healed fissures. Two [5%] patients could not complete the treatment because of severe headache and were excluded. In group B, 37 [92.5%] patients had healed fissures after eight weeks following sphincterotomy. At one week after sphincterotomy 20% had some degree of incontinence to flatus that settled in the majority after eight weeks. One patient developed perianal hematoma that also settled conservatively. On the basis of good clinical results and few adverse effects, glyceryl trinitrate ointment can be employed as first line of treatment in the management of patients with acute anal fissure