Evaluation of clinical effectiveness of topical 0.2% glyceryl trinitrate, topical 2% diltiazem and their combination in the treatment of chronic anal fissure

Background: The longitudinal tear or defect in the epithelial lining of the anal canal distal to the dentate line is called anal fissure. It is of two types: acute and chronic. The break in the cycle of pain, spasm and ischemia is essential for successful treatment of anal fissure. Among multiple non-surgical treatment approaches, the appropriate approach with good patient compliance might be the use of topical agents as chemical sphincterotomy. However, the effectiveness of these agents has not been evaluated widely. Objectives: To evaluate clinical effectiveness of topical 0.2% glyceryl trinitrate, topical 2% diltiazem and their combination in the treatment of chronic anal fissure. Methodology: The study was prospective comparative type including total 158 patients. Initially, they were given first line therapy followed by chemical sphincterotomy agents. The study drugs were given to 84 patients (three groups - 0.2% glyceryl trinitrate, 2% diltiazem and their combination) who were not healed after initial therapy. Patients were assessed for pain using visual analogue scale and other symptoms prior to and after two and six weeks of therapy. Results: Complete healing rate was higher with combination (92.86%) than individual agents. The reduction of visual analog scale score within each group and between the groups in the period between before and after treatment was found to be statistically significant. Headache and hypotension were the common side effects seen during study. Conclusion: Anal fissures can be successfully managed by chemical sphincterotomy. The topical nitrates and calcium channel blockers in combination are found to be effective choice rather than individual agents.

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Topical diltiazem versus topical glyceryl trinitrate in the treatment of chronic anal fissure: a prospective comparative study

International Surgery Journal ◽

10.18203/2349-2902.isj20191088 ◽

2019 ◽

Vol 6 (4) ◽

pp. 1127

Author(s):

Venkatesh S. ◽

Srinivas B. Kulkarni ◽

Kruthi S. R.

Keyword(s):

Glyceryl Trinitrate ◽

Anal Fissure ◽

Chronic Anal Fissure ◽

Anal Verge ◽

Complete Healing ◽

P Value ◽

Medical College ◽

Chemical Sphincterotomy ◽

Prospective Comparative Study ◽

Topical Glyceryl Trinitrate

Background: Acute anal fissure (AAF) heals spontaneously with conservative line of treatment. Chronic anal fissure (CAF) needs either traditional surgical lateral sphicterotomy or chemical sphincterotomy with topical agents. The present study aims at the effectiveness of topical diltiazem (DTZ) cream over topical glyceryl trinitrate (GTN) ointment in the treatment of chronic anal fissure.Methods: A total of 100 patients with CAF were included in this comparative prospective study conducted in Rajarajeswari Medical College and Hospital Bengaluru from July 2017 to December 2018. Eligible patients were randomly assigned to one of the two treatment groups of 50 patients each and were advised to apply 2% DTZ cream or 0.2% GTN ointment by fingertip to the anal verge twice daily for 8 weeks. The results were analysed and compared on two weekly intervals to know the effectiveness of treatment. P value of <0.05 is considered to be significant.Results: Complete healing of the fissure occurred in 80% of the patients in DTZ group against 76% in the GTN group by the end of 6 weeks (p>0.05, statistically not significant). Mild headache was experienced by 14% of the patients in the DTZ group, while 46% of the cases in the GTN group reported about the same (p<0.05 statistically significant).Conclusions: Topical 2% DTZ appeared to be well tolerated and effective preferred first-line method of chemical sphincterotomy with less side effects for chronic anal fissure.

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Utility of Ultrasound in the Evaluation of Chronic Anal Fissure

Surgical Case Reports ◽

10.31487/j.scr.2020.11.01 ◽

2020 ◽

pp. 1-4

Author(s):

Ashraf Talaat Youssef ◽

Ashraf Talaat Youssef

Keyword(s):

Anal Fissure ◽

Anal Sphincter ◽

Internal Anal Sphincter ◽

Chronic Anal Fissure ◽

Transvaginal Ultrasound ◽

Clinical History ◽

Dentate Line ◽

Chemical Sphincterotomy ◽

Healing Response ◽

Asymptomatic Patients

Introduction: Anal fissure is a linear tear in the anal mucosa seen distal to the dentate line. The diagnosis of chronic anal fissure depends on clinical history, physical exam, anoscopy and other imaging modalities are uncommonly recommended unless an associated condition was suspected. Management is either by chemical sphincterotomy or surgery through lateral internal sphincterotomy when chronic anal fissure was resistant to treatment. Purpose of the Study: The current study aimed to evaluate the sonographic findings that can be observed in cases with chronic anal fissure and their significance. Methodology: 15 asymptomatic patients and 30 patients with chronic anal fissure were examined with 3 dimensional transperineal ultrasound and if females an additional transvaginal ultrasound was performed. Results: 26 patients (86.5%) showed diffusely thickened internal anal sphincter of mean thickness >3.5mm, ranging from 3.7 mm to 6.4mm and the mean value was 5mm. 3 patients (10%) with posterior fissure showed a lucent narrow defect in the internal anal sphincter at the midline of the distal aspect of the anal canal wall. One of them showed associated localized intersphincteric plane sepsis. Conclusion: Use of ultrasound in cases with chronic anal fissure may show gapping of the internal anal sphincter and an associated intersphincteric plane sepsis corresponding to the high morphological grade of anal fissure which predict poor healing response to chemical sphincterotomy and further studies that correlate between the thickness and texture of IAS and the healing response to chemical sphincterotomy recommended.

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Effectiveness of 0.2% Glyceryl trinitrate and 0.5% Nifedipine in the Treatment of Chronic Anal Fissure

Journal of Nepal Medical Association ◽

10.31729/jnma.2990 ◽

2017 ◽

Vol 56 (205) ◽

pp. 149-152 ◽

Cited By ~ 3

Author(s):

Suman Kumar Shrestha ◽

Prabin Bikram Thapa ◽

Dhiresh Kumar Maharjan ◽

Tseten Yonjan Tamang

Keyword(s):

Glyceryl Trinitrate ◽

Anal Fissure ◽

Chronic Anal Fissure ◽

Demographic Data ◽

College Teaching ◽

Complete Healing ◽

Medical College ◽

Main Complaint ◽

Ischemic Ulcer

Introduction: Anal fissure is an ischemic ulcer caused by combination of spasm of internal anal sphincter and poor blood supply to the posterior midline of anal canal. This study aimed to assess the efficacy of Glyceryl Trinitrate and Nifedipine in the treatment of chronic anal fissure. Methods: Ninety patients with symptomatic anal fissure in Kathmandu Medical College Teaching Hospital are allocated for study in two groups of 45 each from March 2013 to April 2014. The patients are assigned alternatively to GTN group and Nifedipine group. All patients were assessed every week till 8 weeks in regards to headache, compliance, healing and recurrence. The patients who had complete healing in 8 weeks were further followed up for 6 weeks to detect recurrence. Results: Patients in the two groups were comparable in regard to demographic data (age and sex) as well as clinical factors. Headache was main complaint of patients using GTN in high percentage (16.6%) than complained by patients using topical Nifedipine (6.9%). This factor led to poor compliance with GTN compared with Nifedipine. Nifedipine showed better healing rate 82.5% compared with GTN 60%. Recurrence was comparable among the two groups. Conclusions: Nifedipine ointment showed better results than GTN ointment in chronic anal fissure regarding headache, compliance, healing and recurrence in 6 weeks of follow up period after complete healing of fissure in 8 weeks. Keywords: anal fissure; glyceryl trinitrate; nifedipine.

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Topical diltiazem versus topical glyceryl trinitrate in the treatment of chronic anal fissure: A randomized clinical trial study

Medpusle International Journal of Surgery ◽

10.26611/1061323 ◽

2020 ◽

Vol 13 (2) ◽

pp. 40-43

Author(s):

Mishal Patel ◽

◽

Jagrutkumar Patel ◽

Sandeep Rao ◽

◽

...

Keyword(s):

Clinical Trial ◽

Glyceryl Trinitrate ◽

Randomized Clinical Trial ◽

Anal Fissure ◽

Chronic Anal Fissure ◽

Topical Glyceryl Trinitrate

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ANAL FISSURE;

The Professional Medical Journal ◽

10.29309/tpmj/2012.19.06.2458 ◽

2012 ◽

Vol 19 (06) ◽

pp. 760-763

Author(s):

SHAUKAT ALI ◽

MUHAMMAD AZIM KHAN ◽

SHAHID MANSOOR NIZAMI

Keyword(s):

Anal Fissure ◽

Chronic Anal Fissure ◽

Age Group ◽

Female Patients ◽

Non Invasive ◽

Chemical Sphincterotomy ◽

Anterior Midline ◽

Study Results ◽

Posterior Midline

Objective: To know the outcome of treatment of chronic anal fissure. Setting: Nishtar Hospital, Multan. Period: January 2011 toJune 2011. Material and methods: A total of 100 patients attending surgical OPD were included in the study. Results: Out of 100 patients, 73(73%) were male and 27 (27%) were female patients. Majority of the patients were from the age group 31-40 years. At posterior midline fissurein ano was present in 91 (91%) patients and at the anterior midline it was in 9 (9%). Pain defecation was seen in all patients, constipation in 95(95%) patients whereas bleeding from rectum in 72 (72%) patients. Conclusions: It is concluded that in patients with chronic anal fissure,chemical sphincterotomy with topical nifedipine ointment is a non-invasive and effective modality.

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Closed lateral Internal Sphincterotomy under local anesthesia in OPD in the treatment of chronic Anal Fissure

Annals of King Edward Medical University ◽

10.21649/akemu.v10i1.1133 ◽

2016 ◽

Vol 10 (1) ◽

Author(s):

Naved Ahmad ◽

Muzaffar Aziz ◽

Faizullah .

Keyword(s):

Postoperative Complications ◽

Anal Fissure ◽

Local Anesthesia ◽

Local Anaesthesia ◽

Chronic Anal Fissure ◽

Dentate Line ◽

Lateral Internal Sphincterotomy ◽

Internal Sphincterotomy ◽

Operative Complications

Objective of this study is to provide best therapy in terms of hospital stay and post operative complications after closed lateral internal sphincterotomy under local anaesthesia in the treatment of chronic anal fissure. It is descriptive type of study carried out at Nishtar Hospital Multan, from February 2001 to April 2001. Thirty patients underwent closed lateral internal sphicterotomy in local anaesthesia in OPD. Internal anal sphincter divided up to dentate line by introducing no.11 surgical blade in the intersphicteric groove. Pts were allowed to go home just after the surgery. Follow up for complications was done for the period of 6months. Mean postoperative stay was for 12 minutes. Postoperative complications were soiling (6.6%), incontinence to flatus (3.3%) and recurrence (3.3%). CLIS can be done safely under local anesthesia in OPD with low complication rate and less postop period of stay.

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Safety and effectiveness of saving sphincter procedure in the treatment of chronic anal fissure in female patients

BMC Surgery ◽

10.1186/s12893-021-01346-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Beatrice D’Orazio ◽

Girolamo Geraci ◽

Sebastiano Bonventre ◽

Dario Calì ◽

Gaetano Di Vita

Keyword(s):

Anal Fissure ◽

De Novo ◽

Chronic Anal Fissure ◽

Complete Healing ◽

Low Grade ◽

Normal Range ◽

Female Patients ◽

Functional Differences ◽

Cutaneous Flap

Abstract Introduction Lateral internal sphincterotomy (LIS) is still the approach of choice for the treatment of chronic anal fissure (CAF) regardless to the internal anal sphincter tone but it is burdened by high risk post-operative faecal incontinence (FI). In female patient there are some anatomical and functional differences of the sphinteric system which make them more at risk of FI and vaginal birth could cause sphinteric lesions affecting the anal continence function. The aim of our study is to evaluate the results of saving sphincter procedure as treatment for female patients affected by CAF. Methods We studied 110 female patients affected by CAF undergone fissurectomy and anoplasty with V–Y cutaneous flap advancement associating pharmacological sphincterotomy in patients with hypertonic IAS. The follow up was at least for 2 years. The goals were patient’s complete healing, the evaluation of FI, recurrence rate and manometry parameters. Results All wounds healed within 40 days after surgery. We recorded 8 cases of recurrences 6 healed with medical therapy and 2 with dilatation. We recorded 2 “de novo” temporary and low grade post-operative cases of FI. Post-operative value of MRP were unmodified in patient with normotonic IAS but significantly lower at 12 months follow up as compared with the pre-operative ones in patients with hypertonic IAS; after 24 months from surgery MRP values were within the normal range. Conclusion The fissurectomy and anoplasty with V–Y cutaneous flap alone or in association with a pharmacological sphincterotomy in patients with hypertonic IAS may represent an effective approach for the treatment of CAF in female patients.

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