A Comparative Study of Topical Glyceryl Trinitrate Therapy Versus Lateral Sphincterotomy in Treatment of Chronic Anal Fissure

Background: An anal fissure is a longitudinal tear or defect in the skin of the anal canal distal to the dentate line. An anal fissure is one of the most painful conditions encountered in surgical practice and causes considerable morbidity and reduction in quality of life. Aims: We aim to compare the efficacy of topical Glyceryl Trinitrate (GTN) versus lateral internal sphincterotomy (LIS) in the treatment of chronic anal fissure. Patients and Methods: This study is a randomized clinical study carried out on consecutive patients who attended the surgery outpatient clinics at four hospitals in Sana’a City during the period of a year and a half (from October 2019 to April 2021). This study included 60 patients divided into two groups of 30 patients each. One study group was treated with topical application of 0.2% GTN, while another study group was subjected to LIS and all 60 patients were followed for a period of 6 weeks and observed. Results: Among all the 60 patients (34 females, 26 males) all patients had come with complaints of pain. A total of 45 (75%) patients had pain with constipation, whereas 33 (55%) patients had bleeding per rectum along with pain. On clinical examination tenderness was elicited in all 60 patients, hypertonic anal sphincter elicited in 44 (73.3%), sentinel skin tag was noted in 18 (30%) patients. Group A included 30 (13 males, 17 females) patients treated with topical GTN ointment and group B included (13 males, 17 females) patients who underwent LIS. In group A, 26 patients were treated successfully but 4 patients were uncured. By contrast, all patients in group B were successfully treated (29) patients and only one (3.33%) patient came with unexplained discomfort, and 2 (6.67%) patients suffered from flatus incontinence Conclusion: Despite good response to topical GTN treatment, it seems that LIS is more effective in the treatment of anal fissure with a high rate of healing, good symptomatic relief and very low rate of early incontinence. Medical treatment by GTN can be considered as a satisfactory first-line option in chronic anal fissure treatment.