Comparative study of Glyceryl Trinitrate ointment versus lateral internal sphincterotomy in management of Chronic anal fissure.

Objectives: To compare efficacy of topical 0.2% glyceryl trinitrate ointment with lateral internal sphincterotomy in treatment of patients with chronic anal fissure. Study Design: Randomized Control Trial. Setting: Department of General Surgery, DHQ Teaching Hospital, Sahiwal. Period: From 20 September 2016 to 31 December 2017. Material & Methods: A total number of 60 patients included in this study and divided into two groups GTN and LIS group through computer generated randomization method. Three main outcome variables were assessed in this study; pain relief, healing of fissure and recurrence. SPSS version was used to analyze data. P value ≤ 0.05 was considered as significant. Results: A total number of 60 patients included in this study. Relief of pain GTN and LIS was (95%) and (86.7%) respectively. Fissure healing GTN and LIS was noted as (88.3%) and (83.3%) respectively. Recurrence was not found in any patient of the present study. Relief of pain was statistically significant. Conclusion: Topical application of GTN ointment for relief of pain is safe and effective method for relief of chronic anal fissure but pain relief is slow. On other hand lateral internal sphincterotomy is first line treatment and treatment of choice for chronic anal fissure when performed by an experienced surgeon.

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Comparative Study of Glyceryl Trinitrate Ointment versus Lateral Internal Sphincterotomy in Management of Chronic Anal Fissure

Archives of Clinical Gastroenterology ◽

10.17352/2455-2283.000013 ◽

2016 ◽

pp. 013-016

Author(s):

R Godara

Keyword(s):

Comparative Study ◽

Glyceryl Trinitrate ◽

Anal Fissure ◽

Chronic Anal Fissure ◽

Lateral Internal Sphincterotomy ◽

Internal Sphincterotomy ◽

Glyceryl Trinitrate Ointment

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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 ◽

10.3329/bmrcb.v34i1.1163 ◽

1970 ◽

Vol 34 (1) ◽

pp. 12-15 ◽

Cited By ~ 10

Author(s):

Md. Ibrahim Siddique ◽

Khandker Manzoor Murshed ◽

M.A. Majid

Keyword(s):

Glyceryl Trinitrate ◽

Anal Fissure ◽

Chronic Anal Fissure ◽

Symptomatic Relief ◽

Symptom Relief ◽

Prospective Trial ◽

Lateral Internal Sphincterotomy ◽

Internal Sphincterotomy ◽

Resting Anal Pressure ◽

Glyceryl Trinitrate Ointment

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 p0.05). 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; SphincterotomyDOI: 10.3329/bmrcb.v34i1.1163Bangladesh Med Res Counc Bull 2008; 34: 12-15

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Comparison of Glyceryl Trinitrate Ointment versus Internal Lateral Sphincterotomy for Anal Fissure Pain Relief

10.53350/pjmhs2115102600 ◽

2021 ◽

Vol 15 (10) ◽

pp. 2600-2601

Author(s):

Imran Sadiq ◽

Muhammad Javed Shakir ◽

Ruqqia Naheed Khan ◽

Muhammad Akhlaq Ahmed ◽

Syeda Samina Ashfaq ◽

...

Keyword(s):

Pain Relief ◽

Anal Canal ◽

Glyceryl Trinitrate ◽

Anal Fissure ◽

Distal Part ◽

Chronic Anal Fissure ◽

Lateral Sphincterotomy ◽

Reliable Procedure ◽

Glyceryl Trinitrate Ointment

Background: Anal fissure is a linear painful mucosal tearing in the distal part of anal canal. It extends from dentate to anal edge. Aim: To compare the glyceryltrinitrate ointment and internal lateral sphincterotomy for anal fissure pain relief in acute/chronic pts. Study Design: Prospective study Place and duration of study: Department of Surgery Unit-II, Fatima Memorial Hospital, Shadman Lahore from 1st October 2018 to 31stDecember 2020. Methodology: 40 pts with acute and chronic anal fissure were enrolled. Half of the patients undergo internal lateral sphincterotomy while other opted 0.2% use of glyceryl trinitrate ointment. Each patient was followed for pain, recovery, complications and recurrence until 12 months for internal lateral sphincterotomy and 18 months in glyceryl trinitrate ointment. Results: There were 24 males and 16 females with a mean age of patients as 30±3.2 years. Initial follow-up of patients showed 100% pain and fissure improvement in internal lateral sphincterotomy group as compared to 60% in glyceryl trinitrate ointment group respectively. Conclusion: Internal lateral sphincterotomy is most efficient and reliable procedure in relieving anal fissure pains. Keywords: Anal fissure, Internal lateral sphincterotomy, Glyceryl trinitrate

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Lateral internal sphincterotomy is not redundant in the era of glyceryl trinitrate therapy for chronic anal fissure

Journal of the Royal Society of Medicine ◽

10.1177/014107689909200406 ◽

1999 ◽

Vol 92 (4) ◽

pp. 186-188 ◽

Cited By ~ 14

Author(s):

M Jonas ◽

D N Lobo ◽

A M Gudgeon

Keyword(s):

Glyceryl Trinitrate ◽

Anal Fissure ◽

Chronic Anal Fissure ◽

Lateral Internal Sphincterotomy ◽

Internal Sphincterotomy

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Comparative evaluation of fissurectomy versus lateral internal sphincterotomy in the treatment of chronic anal fissure

International Surgery Journal ◽

10.18203/2349-2902.isj20181120 ◽

2018 ◽

Vol 5 (4) ◽

pp. 1407

Author(s):

A. R. Bansal ◽

Pradeep Yadav ◽

Suvendu Jena ◽

Sanjeev Kumar

Keyword(s):

Side Effects ◽

Pain Relief ◽

Anal Fissure ◽

Comparative Evaluation ◽

Chronic Anal Fissure ◽

Symptomatic Relief ◽

Age Groups ◽

Complete Healing ◽

Lateral Internal Sphincterotomy ◽

Internal Sphincterotomy

Background: Anal fissure is a common anorectal condition that affecting all age groups, but it is seen in young and healthy adults with equal incidence across both the sexes. The objective of this study was to evaluate and prospectively compare fissurectomy versus lateral internal sphincterotomy in the treatment of chronic anal fissure in terms of symptomatic relief, healing, recurrence and incontinence, if any.Methods: 50 patients with chronic anal fissure were alternately divided in two groups. In one group fissurectomy was done and in another group, patients underwent lateral internal sphincterotomy and comparative evaluation was done.Results: Complete healing was observed in 92% patients in fissurectomy group and 96% patients in lateral internal sphincterotomy group at the end of 6 weeks. Fissurectomy group patients reported early cut through of sutures and infection whereas in lateral internal sphincterotomy group two patients developed perianal hematoma at 3 months of follow up.Conclusions: While considering surgical management for treating chronic anal fissure, fissurectomy is comparable to lateral internal sphincterotomy in terms of symptomatic pain relief, healing rates with minimal side effects and low recurrence.

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