Topical nitroglycerin versus lateral internal sphincterotomy for chronic anal fissure

BACKGROUND: To compare the effectiveness of local glyceryl trinitrate (GTN) versus internal sphincterotomy in the management of chronic anal fissure. METHODS: Eighty patients with chronic anal fissure were enrolled in the study. They were divided into two groups; group (1) included 40 patients treated with topical GTN 0.2% on liposomal base applied to the anoderm twice daily and group (2) included 40 patients treated with internal sphincterotomy. We compared the effectiveness of both techniques in the management of chronic anal fissure. RESULTS: In group 1, healing of fissures occurred in 85% of patients after 8 weeks therapy. Headache as a side effect developed in 65% of patients. In group 2, healing occurred in 97.5% of patients after 8 weeks. Incontinence to flatus occurred in 3 patients (7.5%), mild soiling in 2 patients (5%), and one patient developed wound infection. All complications were temporary except for one patient with persistent incontinence to flatus. At the end of 8 weeks both groups were equal in pain scoring. CONCLUSIONS: Topical GTN should be the initial treatment in chronic anal fissure while internal sphincterotomy may be reserved for patients who did not respond to GTN therapy and those with severe pain (as healing is faster with sphincterotomy).