Topical Nitroglycerin versus Lateral fnternal Sphincterotomyin Treatment of Chronic Anal Fissure

Abstract

Background: Anal fissure is common conditions that can affect people of all ages. Most anal fissures are at the rear of anal opening in line with cleft of the buttocks. There are many methods of treatment such as: medication by topical nitroglycerin or nifedipine paste or butulinum toxin injection or surgery by lateral internal Sphincterotomy or V-Y advancement flap.
 Objectives: Is to compare the result of topical GTN (chemical Sphincterotomy) as primary treatment of chronic anal fissure with lateral internal Sphincterotomy.
 Methods:
 Setting: In outpatient clinic and Tikrit teaching hospital from Jan. 2006 to Oct0.2007.
 Design: prospective study.
 This study compares the results of two different methods of treatment (chemical sphinecterotomy&lateral internal Sphincterotomy) in 84 cases of chronic anal fissure regarding the efficacy and complication of these procedures.
 These cases were randomized in equal number into two groups:
 Group 1: were treated by chemical Sphincterotomy.
 Group 2: were treated by lateral internal Sphincterotomy.
 The average period of follow up after completion of treatment was 3 months for both groups.
 Results:
 Symptomatic improvement occurs in 30 patients treated by chemical Sphincterotomy (71.42%) at 12 weeks following treatment and 39 patients (92.85%) treated by lateral internal Sphincterotomy.
 No improvement occurs in 3 cases (7.15%) treated by chemical Sphincterotomy and no case who was treated by lateral internal Sphincterotomy.
 Conclusion: From this study we find that chemical Sphincterotomy induce rapid healing of chronic anal fissure with 71.42% rate in comparison to lateral internal Sphincterotomy with a 92.85% healing rate after 12 weeks treatment,