A team from the Queen Elizabeth Hospital, Woodville, Australia compared glyceryl trinitrate with lateral sphincterotomy, the current standard treatment, as definitive management for chronic anal fissure.
The researchers randomly assigned 65 patients with symptoms of chronic anal fissure to one of two management strategies.
The glyceryl trinitrate group (n=34) applied 0.2 per cent paste to the perianal area 3 times a day, for 8 weeks.
Patients in the lateral sphincterotomy group (n=31) underwent surgery on the next available operating list.
Patients were reviewed at 2-weekly intervals until the fissure healed. 5 patients were excluded after randomization.
The team found that 61 per cent of glyceryl trinitrate patients had healed fissures in 8 weeks, compared with 97 per cent in the sphincterotomy group.
Patients with healed anal fissures at 8 weeks:
Glyceryl trinitrate - 61%
Sphincterotomy - 97%
12 patients in the glyceryl trinitrate group had little improvement in their symptoms and underwent lateral sphincterotomy.
Poor tolerance and poor compliance with treatment were important factors for those patients whose fissures did not heal with glyceryl trinitrate.
Fissures healed significantly faster after sphincterotomy, compared with glyceryl trinitrate treatment. 9 of the 20 patients whose fissures healed with glyceryl trinitrate paste subsequently had a recurrence of their fissures. There were found to be no long-term complications from lateral sphincterotomy.
Dr Justin Evans said on behalf of the group, "Glyceryl trinitrate paste heals the majority of chronic anal fissures. However, a significant minority has little improvement, or develop side-effects, and require conventional surgical treatment. Poor compliance with prescribed treatment often contributes to non-healing. In addition, some fissures that initially heal with glyceryl trinitrate paste recur and require further treatment."
"Glyceryl trinitrate treatment is labor-intensive for patients and physicians and has not been shown to be superior to lateral sphincterotomy," he concluded.