Glyceryl trinitrate cream versus lateral sphincterotomy in management of chronic anal fissure: a prospective randomized comparative study

Abstract

Objective The aim is to compare complications and long-term outcome of two treatment modalities of chronic anal fissure: chemical sphincterotomy by glyceryl trinitrate (GTN) cream and lateral internal sphincterotomy. Background Treatment of chronic anal fissure is achieved by the reduction in the tone of the internal anal sphincter either chemically or surgically. Patients and methods In the period from November 2013 to October 2015, all patients who were admitted to the Department of General Surgery in Shebin Elkom Teaching Hospital complaining of chronic anal fissure were included in the study. According to inclusion and exclusion criteria, patients were selected and distributed randomly into two groups: group A had surgical treatment in the form of lateral internal sphincterotomy, and group B received topical treatment in the form of GTN cream. Patients’ data such as name, age, sex, history, and examination findings along with the results of investigations were collected. Healing and complications were recorded. All data were then analyzed. Results A total of 30 patients were treated and followed up during 3 years. Patients in group A showed higher healing and complication rates than patients in group B. Conclusion Lateral sphincterotomy is an effective method in treating chronic anal fissure, whereas GTN is much less effective on long-term outcome.