Role of Topical Glyceryl Trinitrate in the Management of Anal Fissure

Abstract

Objective: 1) To evaluate the effectiveness of topical 0.2% Glyceryl Trinitrate (GTN) ointment in symptomatic relief and healing of anal fissure 2) To establish the role of GTN as a first line treatment for both acute and chronic anal fissure. 3) To elaborate the safety profile of GTN with respect to its side effects. Design: Prospective, randomized case control study. Place of studs: Surgical unit II, Jinnah Hospital, Lahore. Duration of Study: I year from 1-2-2005 to 31-2-2006. Materials and Methods: Fifty patients of all ages and either sex with a clinical diagnosis of fissure in ano (both acute and chronic) were included in the study. Patients were randomly divided into two groups. The treatment group (Group-A) was advised 0.2% GTN ointment whereas the control group (Group-B) was prescribed a local anesthetic ointment (Lignocaine Compound® Knoll). Both groups applied the given drugs twice daily for a period of 8 weeks and follow-up at the end of first, second and eighth week was carried out. A long-term follow-up at the end of 6 months was undertaken to look for any recurrence of the disease. Results: 18 patients out of 50 patients presented with acute anal fissure while 32 presented with chronic anal fissure.77% of patients with acute fissure in Group A showed fissure healing while 44% of patients with acute fissure were benefited in Group B. When the failures of group B were subjected to GTN, 80% of the patients showed healing of their fissures. 81% of patients suffering from chronic anal fissure were cured in Group A while 25% of patients showed improvement in Group B. Non benefited patients in group B when subjected to GTN, 66% showed fissure healing. Recurrence vas seen in 8 patients in group A (24%) and 3 patients in group (38%) at long term follow-up. Conclusion: Anal fissure is a common general surgical problem associated with severe anal pain. Regarding conservative treatment, the advent of GTN is a healing hope for patients with anal fissure. It has revolutionized the non-surgical treatment, as it is effective, safe and economical in terms of cure of both acute and chronic anal fissures.