Treatment of anal fissure with glyceryl trinitrate in patients referred for surgical management

Background: A number of recent studies indicate that anal fissure may be tr eated by applying glyceryl trinitrate (GTN) ointment. The present study aim s to determine the effectiveness and patient acceptability of GTN treatment for patients referred to a consultant surgeon. Methods: A prospective study of 65 consecutive patients referred to one sur geon (ALP) over a 12-month period was undertaken. All patients were offered 0.2% GTN ointment to be applied intra-anally four times daily for 4 weeks. Informed consent was obtained and review planned for 4 weeks. Results: Fourteen patients declined treatment and nine of the 14 (64%) subs equently underwent lateral sphincterotomy. Twelve of the 51 patients (18.5% ) who accepted treatment could not complete it due to headache or persistin g severe anal pain. Thirty-nine of the 51 patients (77%) were able to compl ete 4 weeks of treatment. Twenty-two of the 39 reported an improvement in s ymptoms. A total of 22 patients (43%) who started GTN treatment subsequentl y underwent lateral sphincterotomy. Conclusions: Evidence from the present study suggests that GTN ointment has a place in the management of referred patients with severe and/or chronic anal fissure, but sphincterotomy remains an important treatment option for the majority.