Published: 2020-08-27

A comparison of efficacy between 0.2% of topical glyceryl trinitrate and lateral anal sphincterotomy

Vivian Anandith Paul, Katpally Nagesh Reddy, Alluru Sarath Chandra


Background: Anal fissure is a linear tear in the lining of the anal canal below the dentate line. Among the conservative modalities glyceryl trinitrate (GTN) is emerging as first line of treatment since it breaks the vicious cycle and relaxes the sphincter. Surgery was considered as the first line of treatment if conservative measures such as bulk laxatives, stool softeners and local anaesthetics fail. Aim of this study was to study the aetiology and predisposing factors, age and sex distribution, clinical presentation, position of fissure, complications associated with medical and surgical management and comparison of efficacy of topical GTN (0.2%) and lateral anal sphincterotomy.

Methods: The study was based on analysis of 60 patients who were treated for chronic fissure in ano at Malla Reddy Institute of Medical Sciences, Hyderabad from January 2018 to February 2020. Patients were divided into 2 groups. One group was managed by topical application of the ointment and other group was managed by surgery (lateral anal sphincterotomy). Statistical tool (software) used to analyse the data was SPSS 13.0 software.

Results: Around 33.33% patients who were managed medically by 0.2% glyceryl trinitrate did not have relief of symptoms. Patients under surgical management had more relief of symptoms (86.6%). Almost all patients treated with glyceryl trinitrate had some form of headache. During the immediate post-operative period 13.3% patients treated with surgery had pain.

Conclusions: It can be concluded that open lateral anal sphincterotomy is superior to topical 0.2% GTN with high rate of healing and very low rate of complications.


Medical management, Surgical management, Fissure

Full Text:



Lindsey I, Jones OM, Hellmich G, Petersen S. Chronic anal fissure. Br J Surg. 2004;91:270-9.

Simpson J, Lund JN, Thompson RJ, Kapila L, Schlefield JH. The use of GTN in the treatment of chronic anal fissure in children. Med Sci Monit. 2003;9 (pt 1):123-6.

Haq Z, Rahman M, Chowdhury RA, Baten MA, Khatun M. Chemical sphincterotomy- first line treatment for chronic anal fissure. Mymesingh Med J. 2005;14:88-90.

Lysy J, Israeli E, Levy S, Rozentzweig G, Strauss- Liviatan N, Goldin E. Long-term results of chemical sphincterotomy for chronic anal fissure: a prospective study. Dis Colon Rectum. 2006;49:858-64.

Scholefied JH, Bock JU, Marla B, Richter HJ, Athanasiadis S, Prols M, et al. A dose finding study with 0.1%, 0.2% and 0.4% glyceryltrinitrate ointment in patients with chronic anal fissures. Gut 2003;52:264-9.

Zubaeri BF, Baloch Q, Abro H. Glyceryl trinitrate ointment in the treatment of anal fissures. J Coll Physicians Surg Pak. 1999;9:410-12.

Christie A, Guest JF. Modelling the economic impact of managing a chronic anal fissure with a proprietary formulation of nitroglycerin (rectogesic) compared to lateral internal sphincterotomy in the United State. Int J Colorectal Dis. 2002;17:259-67.

Essani R, Sarkisyan G, Beart RW, Ault G, Vukasin P, Kaiser AM. Cost saving effect of treatment algorithm for chronic anal fissure: a prospective analysis. J Gastrointest Surg. 2005;9:1237-43.

Mentes BB, Ege B, Leventoglu S, Oguz M, Karadag A. Extent of lateral internal sphincterotomy: up to the dentate line or up to fissure apex. Dis Colon Rectum. 2005;48:365-70.

Oh C, Divino CM, Steinhagen RM. Anal fissure 20 years-experience. Dis Colon Rectum. 1995;38:378-82.

Abcarian H, Lakshmanan S, Read DR, Roccaforte P. The role of internal sphincter in chronic anal fissures. Dis Colon Rectum. 1982;25:525-8.

Reddy S, Sreeramulu PN, Abraham A, Praveen GP, Reddy M, Deepthi R. Surgical management of anal fissure versus glyceryl trinitrate ointment: a comparative prospective study. Int Surg J. 2018;5(6):2205-10.

Yetisir F, Salman AE, Yurekli B, Aksoy M, Yildirim MB, Kilic M, et al. Comparison of lateral internal sphincterotomy with topical nitroglycerine treatment in patients with chronic anal fissure: a prospective randomised study. Surgery Curr Res. 2012;123:1076-77.

Tauro LF, Shindhe VV, Aithala PS, Martis JJS, Shenoy D. Comparative study of glyceryl trinitrate ointment versus surgical management of chronic anal fissure. Indian J Surg. 2011;73(4):268-77.

Anandaravi BN, Ramaswami B. Closed versus open lateral internal anal sphincterotomy in a chronic anal fissure. Int Surg J. 2017;4(3):1055-8.