PURPOSE: There has been an emerging trend to treat chronic anal fissures by
pharmacologic means. In particular, by the topical application of glyceryl
trinitrate. However, such treatment has failed to gain wide acceptance wit
hin our local surgical community. The aim of this study was to evaluate the
efficacy and patient acceptance of topical glyceryl trinitrate in the mana
gement of chronic anal fissures. Methods: A retrospective review was conduc
ted on a consecutive series of 31 patients who were diagnosed as having a c
hronic anal fissures and were managed by the topical application of 0.2 per
cent glyceryl trinitrate to the perianal region twice a day. All patients w
ere commenced on a high-fiber diet, and they were reviewed every two weeks
until healed or until surgery was required. Patients were subsequently cont
acted by a mailed questionnaire to determine compliance with therapy, resol
ution of symptoms, recurrence of symptoms after cessation of therapy, and s
ide effects. RESULTS: Of 31 patients, 27 completed the questionnaire. Only
67 percent (18/27) of patients complied with the treatment as prescribed, a
nd just 56 percent (15/27) achieved complete resolution of their symptoms a
fter three to ten weeks of therapy. Recurrence of symptoms developed in 27
percent (4/15) of these patients after a median follow-up of six months. Si
de effects were reported in 78 percent (21/27) of patients, and in ten perc
ent (2/21) they were so severe that the patients ceased therapy. CONCLUSION
: In this study the treatment of chronic anal fissures with topical glycery
l trinitrate appeared less efficacious than previously reported. In additio
n, the study highlighted problems with patient compliance, healing rates, a
nd side effects that are associated with this modality therapy.