Although there is enthusiasm for nonoperative management of anal fissures, most trials have been of short duration, and long-term outcome is unknown.
Dr Carl Brown and colleagues from Canada assessed the effectiveness of nitroglycerin with internal sphincterotomy in the treatment of chronic anal fissure
The doctors evaluated 2 cohorts of patients in a randomized controlled trial.
|Sphincterotomy patients were less likely to have symptoms|
|Diseases of the Colon & Rectum|
The team of doctors assessed 82 patients with chronic anal fissure.
The doctors randomized the patients to 0.25% nitroglycerin ointment t.i.d. or lateral internal sphincterotomy between 1997 and 1998.
In 2004, a telephone survey of trial participants was conducted to determine symptom recurrence.
The team also assessed the need for further medical and/or surgical treatment, and patient satisfaction.
The patients were assessed for symptoms of fecal incontinence.
The doctors used the Jorge and Wexner Fecal Incontinence Score and the Fecal Incontinence Quality of Life questionnaire.
The doctors found that 82 patients completed the survey.
Mean follow-up was 79 months.
Sphincterotomy patients were less likely to have experienced fissure symptoms within the past year.
The doctors observed that sphincterotomy patients were less likely to require subsequent surgical treatment than patients treated with nitroglycerin.
The team found that patients in the lateral internal sphincterotomy group were more likely to say that they were ‘very' or 'moderately' satisfied with their treatment.
More patients in the internal sphincterotomy group than in the nitroglycerine group stated that they would choose the same treatment again.
Finally, the fecal incontinence and fecal incontinence quality of life scores at 6-year follow-up were similar in both groups.
Dr Brown's team concluded, "After 6 years of follow-up, it seems that lateral internal sphincterotomy is a more durable treatment for chronic anal fissure."
"Compared with topical nitroglycerin therapy and does not compromise long-term fecal continence."
"Thus, sphincterotomy continues to be a good treatment for patients with chronic anal fissure."