Effectiveness and Complications of 0.2% Glyceryl Trinitrate in the Treatment of Chronic Anal Fissure

Background: The aim of this study was to analyze the effectiveness and morbidity of chemical sphincterotomy by 0.2% glyceryl trinitrate (GTN) in the treatment of chronic anal fissure. The main end points were symptom relief, fissure healing and side effects. Methods: A prospective study was conducted to see the effectiveness and side effects of 0.2% glyceryl trinitrate in the treatment of patients with chronic anal fissure attending the outpatient department of surgery from February 2004 to the end of February 2005. All the patients were followed up at 2 weeks interval for 8 weeks. The primary focus was fissure healing and the secondary focus were on improvement of symptoms, need for surgical sphincterotomy and side effects. Results:One hundred and twenty two adult patients, both male and female with chronic anal fissure were treated with local application of 0.2% glyceryl trinitrate. Pain relief occurred earlier than fissure healing. At the end of 8 weeks treatment about two third of the total patients got complete pain relief and fissure healing. Headache was the major side effect. Conclusion: Topical application of 0.2% glyceryl trinitrate (GTN) should be the initial treatment of choice for chronic anal fissure to avoid the long term complication of incontinence following surgical sphincterotomy.