ABSTRACT

Objective: To compare the efficacy in terms of Pain relief in 0.2% Glyceryl Trinitrate ointment versus fissurectomy with lateral internal sphincterotomy in the management of chronic anal fissure.

Study Design: Randomized controlled trial

Place and Duration: This study was conducted at Surgical Unit, DHQ Teaching Hospital, Rawalpindi over a period of 06 months starting from April 2015 to September 2015.

Methodology: 100 patients of chronic anal fissure were included in the study. Patients were divided equally into two treatment groups A & B. Group ‘A’ was treated with 0.2% Glyceryl Trinitrate and Group‘B’ was treated by Lateral Internal Sphincterotomy. Efficacy regarding pain relief was assessed by visual analogue scale (VAS). Patients were followed for 2 weeks. Data was analyzed by SPSS 27.0.

Results: 64 patients (64%) were male and 36 patients (36%) were female (n=36). Mean age of patients was 31.36±9.68 years. Mean duration of symptoms was 14.83±7.01 weeks. 75% patients had posterior anal fissure while 25% had anterior anal fissure. At the end of 02 weeks of treatment, follow up Overall pain free outcome was seen in 35 (70 %) patients (n=50) in group A and 48 (96%) patients (n=50) in group B and on statistical basis there was significant difference in pain free outcome between the two groups (p-value <0.05).

Conclusion: Lateral internal sphincterotomy is safe and effective in the management of chronic anal fissure. 0.2% GTN ointment could be used as an alternate to the fissurectomy.

Keywords: Chronic Annal Fissure, 0.2% GTN, Lateral Internal Sphincterotomy, Pain (VAS).