Comparative Study of Lateral Internal Sphincterotomy versus Local 0.4% Glyceryl Trinitrate Ointment for the Treatment of Chronic Anal Fissure

Abstract

Objectives: To compare the outcomes of “Lateral Internal Sphincterotomy (LIS)” versus local “0.4% Glyceryl Trinitrate (GTN)” ointment for the treatment of chronic anal fissure. Study Design and Setting: Randomized controlled trial, Combined Military Hospital (CMH) / Pak Emirates Military Hospital (PEMH), Rawalpindi from October 2022 to March 2023. Methodology: A total of 100 patients [50 in GTN group and 50 in LIS group] who underwent treatment for chronic anal fissure were included in study. Patients in both groups were followed up at eight weeks after the surgery to assess for the outcomes including anal pain healing and recurrence of fissure. Data was analyzed by SPSS 22.00. Results: In our study, mean age was 30.48 ± 5.82 years. 61 (61.00%) were male while 39 (39.00%) were female. Mean duration of having anal fissure was 10.69 ± 2.59 weeks. Mean post-therapy pain VAS at week 8 follow up in “GTN” group was 0.64 ± 1.06 while in “LIS” group it was 0.16 ± 0.37, (p = 0.003). Complete healing of chronic anal fissure was achieved in 35 (70.00%) in “GTN” group while in “LIS” group healing was achieved in 42 (84.00%), (p = 0.096). Recurrence occurred in 2 (4.00%) of patients in “GTN” group and none in “LIS” group, (p = 0.153). Conclusion: “Lateral Internal Sphincterotomy (LIS)” is a better treatment option for management of chronic anal fissure.