Surgery: Current Research

ISSN - 2161-1076


Comparison of Lateral Internal Sphincterotomy with Topical Nitroglycerine Treatment in Patients with Chronic Anal Fissure: A Prospective Randomised Study

Fahri Yetişir

Aim: Lateral Internal Sphincteromy (LIS) is considered as gold standard in the treatment of chronic anal fissure. However, LIS has complications such as gas and stool incontinence. The aim of the present study was to compare the results of LIS and 0.4% topical nitroglicerin treatment in patients with chronic anal fissure.

Method: 150 patients with Chronic Anal Fissure were prospectively randomised into two Groups of 75 subjects in each. Group I underwent LIS and Group 2 was administered topical nitroglicerin. All patients were given high fibre diet and phsyllium diet before and after the treatment. After follow up period, two Groups were compared in terms of postoperative complications, recurrence rates, loss of work days and patient satisfaction.

Results: Two Groups were similar in terms of demographic data and anal fissures. Recurrence was seen in 4 patients in Group I and 8 patients in Group II. Gas incontinence under stress developed in 7 patients in Group I, in no patient Group II. Anal itching and soiling occurred in 8 patients in Group I, in no patient Group II. In Group II, headache occurred in 12 patients during treatment. Duration of time to return to work and normal activity was longer in Group I.

Conclusion: It is our suggestion that topical nitroglicerin is as effective as surgery in the treatment of chronic anal fissure with absence of incontinence.