Comparative study of glyceryl trinitrate ointment versus surgical management of chronic anal fissure

Background: Fissures are common, but are often confused with other anal conditions, such as haemorrhoids. Fissures are usually caused by trauma to the inner lining of the anus from a bowel movement or other stretching of the anal canal. Aim: This study evaluated the efficacy of 0.2% glyceryl trinitrate versus lateral internal sphincterectomy in treatment of chronic anal fissure. Materials and Methods: This was a study which included 80 patients between November 2014 to September 2017. In this study, based on computer generated randomization, the patients were divided into two groups. Group A consisted of 40 patients with chronic anal fissure who were treated with 0.2% glyceryl trinitrate ointment, which was applied twice daily for 5 weeks. Group B included 40 patients who were treated by lateral internal sphincterotomy. Results: The mean duration of symptoms was 15.35±10.87 weeks in group A, it was 15.02±11.7 weeks in group B. Mean pain score during defecation was 7.89±1.58 in group A, it was 7.52±2.41 in group B. Bleeding during defecation was observed in 82% of patients in group A, 75% of patients in group B. Constipation was present in 27 patients i.e. 67% in group A and it was present in 31 patients i.e. 77% in group B. In Group A, 36 (90%) patients had posterior midline fissure, 4 (10%) had anterior midline fissure, In group B, 40 (100%) had posterior midline fissure. In group A, 24 (60%) had anal tag, in group B, 22 (56%) had anal tag. The VAS score in both the groups decreased gradually but the decrease was more in group B compared to group A at the end of 7th week which was statistically significant (p<0.05). Hence, the number of patients who had pain relief after surgical treatment was statistically significant as compared to patients who were treated with 0.2% glyceryl trinitrate ointment application. At the end of the 1st week, none of the patients were healed completely. But at the end of the 4th, in group A, only 14 patients were completely healed, 38 patients were completely healed in group B. At the end of the 7th week, all patients in group B were healed i.e. 100% were healed and in group A, 32 patients were healed completely. Conclusion: Chemical treatment by applying glyceryl trinitrate is also advantageous in that it doesn't cause any complications. Surgical treatment by lateral sphincterotomy is most effective when patients fail to respond to chemical treatment.