Comparative study of lateral internal sphincterotomy versus local 0.2%glyceryl trinitrate ointment for the treatment of chronic anal fissure

Authors

  • Md. Ibrahim Siddique Department of Surgery, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka 1000, Bangladesh.
  • Khandker Manzoor Murshed Department of Surgery, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka 1000, Bangladesh.
  • M.A. Majid Department of Surgery, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka 1000, Bangladesh.

DOI:

https://doi.org/10.3329/bmrcb.v34i1.1163

Keywords:

Anal fissure, Glyceryl trinitrate, Sphincterotomy

Abstract

The gold standard surgical treatment of chronic anal fissure is lateral internal sphincterotomy which lowers the resting anal pressure and effectively heals the majority of fissures. Local application of 0.2% glyceryl trinitrate ointment has been used as an agent for chemical sphincterotomy, causing temporary alleviation of sphincter spasm and allowing the fissure to heal without compromising the anal continence. The aim of the present study was to compare the results of surgical sphincterotomy with that of local 0.2% glyceryl trinitrate ointment in the treatment of chronic anal fissure. Seventy adult patients between the age of 18 and 50 years with chronic anal fissure were randomized in a prospective trial to receive either surgical sphincterotomy or 0.2% glyceryl trinitrate ointment locally. Patients were followed up at 2 weeksâ interval for 10 weeks. Symptom relief, fissure healing and continence scores were the outcomes assessed. Six patients were excluded for protocol violations. Surgical sphincterotomy was significantly more effective in providing pain relief and was associated with significantly better fissure healing rates at 6 weeks and 10 weeks (both p<0.001). There were substantial problems with compliance in ointment group related to slow healing and longer time needed for symptomatic relief. Minor incontinence was 6% in sphincterotomy group and none in ointment group (p>0.05). Considering early symptomatic relief, rapid fissure healing and better patient compliance surgical sphincterotomy is the treatment of choice for chronic anal fissure.

Keywords: Anal fissure; Glyceryl trinitrate; Sphincterotomy

DOI: 10.3329/bmrcb.v34i1.1163

Bangladesh Med Res Counc Bull 2008; 34: 12-15

Downloads

Download data is not yet available.
Abstract
98
PDF
182

Downloads

How to Cite

Siddique, M. I., Murshed, K. M., & Majid, M. (2008). Comparative study of lateral internal sphincterotomy versus local 0.2%glyceryl trinitrate ointment for the treatment of chronic anal fissure. Bangladesh Medical Research Council Bulletin, 34(1), 12–15. https://doi.org/10.3329/bmrcb.v34i1.1163

Issue

Vol. 34 No. 1 (2008)

Section

Research Papers

License

Authors who publish with this journal agree to the following terms.

Authors retain copyright and grant the journal right of first publication.

Creative Commons Licence
Articles in the Bangladesh Medical Research Council Bulletin are licensed under a Creative Commons Attribution 4.0 International License (CC-BY) that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.

Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.

Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).