A Comparative Study between the Use of Topical Glyceryl Trinitrate Versus Surgical Internal Sphincterotomy for Treatment of Chronic Anal Fissure
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- Category: Vol. 85, June 2017
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A Comparative Study between the Use of Topical Glyceryl Trinitrate Versus Surgical Internal Sphincterotomy for Treatment of Chronic Anal Fissure, MOHAMED M. AL-SAYED, ISMAEIL A. AL-KHAWAGA and REFAAT I. EL-BADAWY
Abstract
Background: The anal fissure is one of the most frequent proctologic problems that affect many patients altering their social and work lives as well. Consequently, it is important to make a proper diagnosis and apply a rapid and effective treatment. It usually starts as a linear tear in the anal canal mucosa, and if healing fails, it evolves into a Chronic Anal Fissure (CAF).
Objective: To make a comparison between the use of topical glyceryl trinitrate and surgical internal sphincterotomy for treatment of CAF.
Patients and Methods: This prospective study included forty patients with CAF divided into two equal groups: The first group underwent surgical treatment in the form of Sub-cutaneous Lateral Internal Sphincterotomy (SLIS), and the second group used the topical treatment in the form of 0.2% glyceryl trinitrate applied twice daily for six weeks. All the patients came to general surgery outpatient clinics at the 6th of October Health Insurance Hospital at Cairo, in the period from May to December 2016. Follow-up was done at regular pre-specified intervals and two main outcomes were outlined: “Fissure healing” and “pain relief” to compare between both groups.
Results: In the first group with surgical treatment, fissure healing rates were as the following; (20%) by 4 weeks, (80%) by 6 weeks and (100%) by 8 weeks. Pain relied rates were (90%) by 2 weeks postoperatively and (100%) by the end of 4th week. With regard to post-operative complications, (65%) of cases had post-operative discharge, (35%) had incontinence to gases but not to stool (0%). And (20%) had pruritis during the first 2 weeks. For the second group subjected to topical treatment, fissure healing rates were (20%) by 4 weeks, (70%) by 6 weeks and (85%) by 8 weeks. Pain relief rates were (65%) by 2 weeks and (100%) by 4 weeks. Regarding treat-ment-related side effects, headache (45%) was the commonest problem, anal itching (35%), three patients (15%) failed to heal and two patients (10%) had recurrence within 6 months. This study has a non significant p-value for the outcome difference between both groups regarding fissure healing and pain relief.
Conclusion: Topical glyceryl trinitrate should still be considered as a first line treatment for CAF, it is safe and produces chemical sphincterotomy without the complications of surgery, plus it is specially useful for patients with recurrent CAF after previous surgical treatment and those unfit or unwilling to undergo surgery. Surgical SLIS should be spared for those who fail conservative topical treatment.