Comparative Study of Lateral Internal Sphincterotomy vs Glyceryl Trinitrate Ointment for Fissure in Ano

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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A comparative study between open and closed lateral internal sphincterotomy using Cataract knife in patients with chronic fissure in ANO

International Journal of Surgery Science ◽

10.33545/surgery.2021.v5.i1g.646 ◽

2021 ◽

Vol 5 (1) ◽

pp. 618-622

Author(s):

Dr. Madhushankar L ◽

Dr. Sridhar G ◽

Dr. Sharath A ◽

Dr. Deepak Lal

Keyword(s):

Comparative Study ◽

Lateral Internal Sphincterotomy ◽

Fissure In Ano ◽

Internal Sphincterotomy

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

The Professional Medical Journal ◽

10.29309/tpmj/2019.26.12.4330 ◽

2019 ◽

Vol 26 (12) ◽

pp. 2241-2245

Author(s):

Waqas Hussain Qureshi ◽

Zahid Sattar ◽

Akhtar Mahboob ◽

Aakif Yousaf ◽

Sajid Mukhtar ◽

...

Keyword(s):

Pain Relief ◽

Glyceryl Trinitrate ◽

Anal Fissure ◽

Chronic Anal Fissure ◽

Lateral Internal Sphincterotomy ◽

P Value ◽

Internal Sphincterotomy ◽

Randomized Control ◽

Glyceryl Trinitrate Ointment ◽

Trial Setting

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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Comparison of efficacy of internal sphincterotomy versus topical 0.2 % glyceryl trinitrate ointment after hemorrhoidectomy.

The Professional Medical Journal ◽

10.29309/tpmj/2020.27.12.4728 ◽

2020 ◽

Vol 27 (12) ◽

pp. 2541-2547

Author(s):

Muhammad Arif ◽

Sabih Nofal ◽

Ahsan Khan ◽

Mariam Tariq Awana ◽

Anum Arif

Keyword(s):

Glyceryl Trinitrate ◽

Controlled Trial ◽

P Value ◽

Chi Square ◽

Male Predominance ◽

Internal Sphincterotomy ◽

Open Hemorrhoidectomy ◽

Group A ◽

Group B ◽

Glyceryl Trinitrate Ointment

Objectives: To compare the efficacy of 0.2% glyceryl trinitrate ointment versus internal sphincterotomy after hemorrhoidectomy. Study Design: Randomized Controlled Trial. Setting: Department of Surgery Unit III, at Lahore General Hospital, Lahore. Period: 6 months (August 2017 to February 2018). Material & Methods: The OPD of the Department of Surgery included 124 patients who satisfied the inclusion criteria. There were two groups of patients, Group A and Group B. Group-A was told to use gloved finger three times daily for 0.2 percent GTN ointment topically. For Group B, lateral internal sphincterotomy was performed as day care procedure. On visit, patients were assessed for pain relief by using VAS. All data was collected using a pre-designed (attached) proforma. In SPSS v23.0 the data were input and analyzed. It was stratified for age, sex, disease duration and hemorrhoid stage. The effectiveness of both groups was compared by using a p-value of 0.05 as significant for a chi-square test. Results: Male predominance; in group-A, 41(66.1%) patients were male and 21(33.9%) were female, while in group-B, 52(83.9%) patients were male and 10(16.1%) were females. Efficacy was found in 11(17.7%) patients in group-A (0.2% GTN) while in 25(40.3%) patients in group-B (Internal sphincterotomy) with p-value of 0.006 which is statistically significant. Conclusion: Open hemorrhoidectomy internal sphincterotomy is an effective method to reduce pain after hemorrhoidectomy in contrast to Glyceryl Trinitrate (GTN) topical cream of 0.2 percent.

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