Clinical efficacy of 0.2% glyceryl trinitrate ointment for anal fissures

Abstract

Objective To validate the clinical efficacy of 0.2% glyceryl trinitrate ointment, a nitric oxide donor, in the management of anal fissures. Patients and methods: A prospective clinical study conducted on consecutive patients with anal fissures presented to the surgical clinic of Jinnah Hospital and Allama Iqbal Medical College Complex Lahore. These patients were treated with topical 0.2% glyceryl trinitrate paste in soft white paraffin three times a day. Patients were examined at regular intervals to evaluate the fissure status, adverse reactions, symptomatic control and recurrence. All subjects were followed-up until they were pronounced cured or treatment terminated. Results: 121 patients comprised this study group. 6 cases were lost to follow-up and 109 (94.7%) of the remaining 115 subjects were cured. Of those cured, 13 (11.3%) presented with acute and 102 (88.7%) chronic fissures. There were 98 male and 17 female patients with median age of 41 years (range, 14-70 years). Complete symptomatic relief w as achieved in all patients within one month of therapy. Treatment had to be terminated in 6 (5.2%) patients: 5 (4.3%) experienced intolerable adverse effects and 1 (0.8%) patient failed to respond. All these cases were successfully treated with lateral internal sphincterotomy. There was no change of continence in this series. Conclusion: Glyceryl trinitrate ointment produces healing of the anal fissures and adequate symptomatic relief and should be considered as the first line treatment for anal fissures.