COMPARISON BETWEEN TREATMENT EFFICACY OF GLYCERYL TRINITRATE AND LATERAL SPHINCTEROTOMY FOR CHRONIC ANAL FISSURE
Main Article Content
Keywords
Chronic anal fissure, Glyceryl trinitrate, Lateral sphincterotomy
Abstract
Background: Chronic anal fissure as a common anorectal disorder with excruciating pain and bleeding on passage of stools. The treatments of choice are universally conservative, as well as surgical interventions.
Objectives: This research aimed to compare the efficacy of glyceryl trinitrate (GTN) ointment and lateral sphincterotomy in treating chronic anal fissure.
Study Design: A Prospective Study.
Duration and Place of the Study: This study was conducted at the Department of General Surgery, Combined Military Hospital, Peshawar, Pakistan over a period of Six Months from 01st January 2023 to 30th, June 2023.
Material and Methods: This is a prospective randomized trial including 2 groups of treatments for 68 patients diagnosed as having chronic anal fissure. GTN group (n=34): topical glyceryl trinitrate 0.2% ointment twice daily Lateral sphincterotomy group (n=34): lateral anal sphincterotomy. At baseline and at 2 weeks, 4 weeks, and 8 weeks the patients were evaluated for symptomatic improvement, healing of fissure, and side effects.
Results: Total 68 patients were included in study, 34 in each group. The mean age of patients was 42.5 ± 11.2 years in the GTN group versus 41.8 ± 10.9 years in the lateral sphincterotomy group. There was no significant difference between age among the two groups (p=0.75). The mean VAS score was 8.2 ± 1.1 in the GTN group at baseline, and it decreased to 3.4 ± 1.3 at 2 weeks, 2.1 ± 1.0 at 4 weeks and then to below the mild pain threshold (1.8 ± 0.9) from week-8.
Conclusion: In terms of relieves of pain, fissure healing and lower recurrence rates lateral sphincterotomy is more effective than glyceryl trinitrate ointment in treatment of chronic anal fissure.
References
2. Coss-Adame, E., Rao, S. S. C., Remes-Troche, J. M., & Valdovinos, M. A. (2021). Pathophysiology and management of anorectal pain syndromes: from diagnosis to treatment. Nature Reviews Gastroenterology & Hepatology, 18(3), 169-183. https://doi.org/10.1038/s41575-020-00387-6
3. Hananel, N., & Gordon, P. H. (1997). Re-examination of clinical manifestations and response to therapy of fissure-in-ano. Diseases of the Colon & Rectum, 40(2), 229-233. https://doi.org/10.1007/BF02054023
4. Altomare, D. F., Binda, G. A., Canuti, S., Landolfi, V., Trompetto, M., Villani, R. D., & Pigot, F. (2021). The management of patients with chronic anal fissure: a position paper. Techniques in Coloproctology, 25(7), 711-726. https://doi.org/10.1007/s10151-021-02465-7
5. Lund, J. N., & Scholefield, J. H. (1997). A randomised, prospective, double-blind, placebo-controlled trial of glyceryl trinitrate ointment in the treatment of anal fissure. The Lancet, 349(9044), 11-14. https://doi.org/10.1016/S0140-6736(96)06198-3
6. Altomare, D. F., Binda, G. A., Canuti, S., Landolfi, V., Trompetto, M., Villani, R. D., & Pigot, F. (2021). The management of patients with chronic anal fissure: a position paper. Techniques in Coloproctology, 25(7), 711-726. https://doi.org/10.1007/s10151-021-02465-7
7. Bacher, H., Mischinger, H. J., Cerwenka, H., Werkgartner, G., El Shabrawi, A., Pfeifer, J., ... & Ratzenhofer, M. (1997). Local glyceryl trinitrate for treatment of anal fissures. Diseases of the Colon & Rectum, 40(6), 840-845. https://doi.org/10.1007/BF02055430
8. Oettle, G. J. (1997). Glyceryl trinitrate vs. sphincterotomy for chronic anal fissure. Diseases of the Colon & Rectum, 40(11), 1318-1320. https://doi.org/10.1007/BF02070723
9. Lindsey, I., Jones, O. M., Cunningham, C., & Mortensen, N. J. (2004). Chronic anal fissure. British Journal of Surgery, 91(3), 270-279. https://doi.org/10.1002/bjs.4452
10. McNamara, M. J., & Kaiser, A. M. (2015). Operative for chronic anal fissure. JAMA Surgery, 150(10), 972-979. https://doi.org/10.1001/jamasurg.2015.1424
11. Nelson, R. L. (2002). Chronic anal fissures. American Journal of Surgery, 183(1), 286-289. https://doi.org/10.1016/S0002-9610(02)00779-6
12. Schouten, W. R., Briel, J. W., & Auwerda, J. J. A. (1996). Anal fissure: new concepts in pathogenesis and treatment. Scandinavian Journal of Gastroenterology, 31(sup218), 3-8. https://doi.org/10.3109/00365529609094759
13. Beck, D. E., Roberts, P. L., Saclarides, T. J., Senagore, A. J., Stamos, M. J., & Wexner, S. D. (2018). The ASCRS Textbook of Colon and Rectal Surgery. Springer. https://doi.org/10.1007/978-3-319-25970-3
14. Carapeti, E. A., Kamm, M. A., McDonald, P. J., & Phillips, R. K. S. (1999). Randomised controlled trial shows that glyceryl trinitrate heals anal fissures whether used topically or orally. Gut, 44(5), 727-730. https://doi.org/10.1136/gut.44.5.727
15. Schouten, W. R., Briel, J. W., & Auwerda, J. J. A. (1994). Relationship between anal pressure and anodermal blood flow. The Lancet, 344(8937), 597-599. https://doi.org/10.1016/S0140-6736(94)91945-8
16. Nelson, R. L., Thomas, K., Morgan, J., & Jones, A. (2007). Non-surgical therapy for anal fissure. Cochrane Database of Systematic Reviews, (4). https://doi.org/10.1002/14651858.CD003431.pub3
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Rashid Zahid Ali
Resident FCPS General Surgery, Combined Military Hospital, Peshawar, Pakistan.
Khurram Bajwa
Consultant General Surgeon, Combined Military Hospital, Peshawar, Pakistan.
Shoaib Ahmed
Consultant General Surgeon, Sheikh Khalifa Bin Zayyad Al Nahyan Hospital, Quetta, Pakistan.
Qaiser Haral
Resident FCPS General Surgery, Combined Military Hospital, Peshawar, Pakistan.
Asad Zafar
Resident FCPS General Surgery, Combined Military Hospital, Peshawar, Pakistan.
Arwah Mansoor
Resident FCPS General Surgery, Combined Military Hospital, Peshawar, Pakistan.