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Abstract
Background: Chronic anal fissure is a widespread and painful anorectal disease, which severely affects quality of life. Topical glyceryl trinitrate (GTN) and lateral internal sphincterotomy (LIS) are commonly used as methods of treatment, although the effectiveness of these methods in comparison to each other is questionable.
Methods:
It was a comparative observational study that took place in Jinnah Postgraduate Medical Centre, Karachi, One hundred chronic anal fissure patients were recruited and subdivided into two groups: Group A (n=50) was treated with topical GTN (0.2% twice daily during six weeks), and Group B (n=50) was treated with LIS. Follow-up of patients was done at 2 weeks, 6 weeks and 3 months. The results measured were the healing rate, pain relief by using the Visual Analog Scale (VAS), recurrence, patient satisfaction, and adverse effects. Data analysis was done with the help of SPSS version 26, and p=0.05 was taken as significant.
Results:
At the six-week follow-up, 76% of GTN patients achieved complete healing compared to 94% in the LIS group (p=0.02). By three months, the healing rates improved to 82% in the GTN group and 98% in the LIS group. Pain relief was significantly better in LIS patients, with 92% being pain-free at three months compared to 78% in the GTN group (p=0.03). The recurrence rate was 18% in the GTN group versus only 2% in the LIS group (p=0.01), confirming the superior long-term efficacy of LIS. Patient satisfaction was higher among LIS-treated patients (88%) compared to GTN-treated patients (64%) (p=0.008). Side effects were more common in the GTN group, with 40% reporting headaches and 22% experiencing dizziness, whereas 6% of LIS patients reported minor incontinence to flatus, with no major complications observed
Conclusion:
LIS is superior to GTN in chronic anal fissure, providing better healing, quicker symptom relief, reduced recurrence, and improved patient satisfaction. GTN is still a viable non-surgical alternative to chosen patients.