Topical glyceryl trinitrate in the treatment of anal fissure

Aim: the aim of this study was to assess the effectiveness of topical glyceryl trinitrate (GTN) in the treatment of anal fissure. Patients: eighty consecutive patients were randomized to receive 0.2% GTN gel twice a day during a minimum of 6 weeks. Of these 80 patients 34 were males and 46 female, with ages between 20 and 78 years. All patients underwent a work-up that included gender, age, symptom duration, site, previous treatment attempts, pain score, associated diseases, and maximum anal resting pressure. These patients were followed at regular intervals of 4, 8, and 12 weeks to assess symptom outcome, rate of healing, adverse effects, and recurrence rate. Results: pain scores were significantly reduced during the treatment period in 65% of cases. After 4 weeks, 55% of patients had healed, and 78% after 9 weeks. In 18 patients (22%), anal fissures did not heal even with 6 additional weeks of treatment, and 12 of them (15%) underwent lateral sphincterotomy. Sixty one percent of patients had flushing and 15% severe headaches. Conclusion: the results of this study have demonstrated the significant benefit of topical GTN when administered to patients suffering from anal fissures.