USE OF TOPICAL GLYCERYL TRINITRATE VERSUS LATERAL INTERNAL SPHINCTEROTOMY IN THE TREATMENT OF CHRONIC ANAL FISSURE
I. Moussa, G., H. Elkhadrawy, O., H. Gad, A., M. Abdulrazeck, M., Baza, O., M., F. (2001). USE OF TOPICAL GLYCERYL TRINITRATE VERSUS LATERAL INTERNAL SPHINCTEROTOMY IN THE TREATMENT OF CHRONIC ANAL FISSURE. EKB Journal Management System, 20(3), 673-678. doi: 10.21608/ejsur.2001.376360
Gamal I. Moussa; Osama H. Elkhadrawy; Abd El Wahab H. Gad; Mahmoud M. Abdulrazeck; Osama Baza; Fouda M.. "USE OF TOPICAL GLYCERYL TRINITRATE VERSUS LATERAL INTERNAL SPHINCTEROTOMY IN THE TREATMENT OF CHRONIC ANAL FISSURE". EKB Journal Management System, 20, 3, 2001, 673-678. doi: 10.21608/ejsur.2001.376360
I. Moussa, G., H. Elkhadrawy, O., H. Gad, A., M. Abdulrazeck, M., Baza, O., M., F. (2001). 'USE OF TOPICAL GLYCERYL TRINITRATE VERSUS LATERAL INTERNAL SPHINCTEROTOMY IN THE TREATMENT OF CHRONIC ANAL FISSURE', EKB Journal Management System, 20(3), pp. 673-678. doi: 10.21608/ejsur.2001.376360
I. Moussa, G., H. Elkhadrawy, O., H. Gad, A., M. Abdulrazeck, M., Baza, O., M., F. USE OF TOPICAL GLYCERYL TRINITRATE VERSUS LATERAL INTERNAL SPHINCTEROTOMY IN THE TREATMENT OF CHRONIC ANAL FISSURE. EKB Journal Management System, 2001; 20(3): 673-678. doi: 10.21608/ejsur.2001.376360

USE OF TOPICAL GLYCERYL TRINITRATE VERSUS LATERAL INTERNAL SPHINCTEROTOMY IN THE TREATMENT OF CHRONIC ANAL FISSURE

The Egyptian Journal of Surgery
Volume 20, Issue 3, July 2001, Page 673-678  XML PDF (527.41 K)
Document Type: Original Article
DOI: 10.21608/ejsur.2001.376360
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Authors
Gamal I. Moussa1; Osama H. Elkhadrawy* 1; Abd El Wahab H. Gad1; Mahmoud M. Abdulrazeck1; Osama Baza1; Fouda M.2
1Department of Surgery - Faculty of Medicine, Tanta University, Egypt
2Department of Pharmaceutics - Faculty of Pharmacy, Tanta University, Egypt
Abstract
A long term failure rate of about 5% to lateral internal sphincterotomy has been leading to a continuous research for a 
new modalities for treatment of chronic anal fissure. The present study was conducted on 100 patients divided into two 
groups. Group I comprised 50 patients for whom lateral internal sphincterotomy was done. Group II comprised 50 patients who were treated by topical application of nitroglycerine ointment 0.2% twice daily for 6-8 weeks. Anal manometric study for all patients revealed that, maximum resting pressure decreased from a mean value of 98 cm H2O preoperatively to 72 cm H2O one week after the operation in group I and decreased from a mean value of 102 cm H2O before treatment to 76 cm H2O after one week of topical glyceryl trinitrate in group II. Pain relief occurred in 80% during the passage of the first motion, 90% had their pain relief in 2 weeks, 95% in 3 weeks and all patients had their discomfort subsided over 4 weeks in group I, while in group II, 85% reported no pain after 2 weeks, 90% after 4 weeks while pain relief was not obtained in 10%. Complete healing was not achieved in any of the patients of both groups after one week, after 2 weeks , 55% in group I and 35% in group II showed complete healing , at the third week 85% in group I and 75% in group II and at the fourth week all patients in group I and 90% in group II showed complete healing . In group I, temporary incontinence to flatus occurred in 5% whom became completely normal in 3 months, recurrence occurred in 3% within 6 months of surgery. In group II, headache occurred in 15%, hypotension in 5% and recurrence within 6 months of stopping treatment in 15%. In conclusion , internal sphincterotomy with fissurectomy was found to be superior to topical nitroglycerine ointment in the treatment of chronic anal fissure. 
Keywords
Anal; fissure; sphincterotomy
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