Effectiveness of Glyceryl Trinitrate in the Treatment of Chronic Anal Fissure

Abstract

Objective: To determine the effectiveness of glyceryl trinitrate (GTN) in the treatment of chronic anal fissure. Study Design: Prospective Study. Place and Duration of Study: Surgical Outpatient department, Khyber Teaching Hospital, Peshawar 06 months (July 2009 to Jan 2010). Materials and Methods: Six months prospective study was carried out at surgical out patient department of Khyber teaching Hospital, Peshawar. Sixty cases of chronic anal fissure not willing for surgical procedure and fulfilling the inclusion criteria were enrolled. Pain was documented using visual analogue scale. Patients were started treatment with local application of Glyceryl Trinitrate (GTN) gel, twice daily and reassessed after 04 weeks and 08 weeks of treatment respectively. Pain and complications were documented. Results: There were 33 (55%) females and 27 (45%) males with mean age of 37. At presentation all patients (100%) perceived pain as severe pain on Visual Analogue Scale. 80% patients had significant relief with GTN application for a period of 02 months. The commonest complication was constipation (26%), followed by infection (10%), sentinel pile (6%) and fistula (5%). Conclusion: Glyceryl trinitrate is very effective in the treatment of chronic anal fissure and is the drug of choice in conservative treatment of anal fissures and in patients with contraindications for surgery.