AN AGGRESSIVE APPROACH TOWARDS TREATMENT OF ACUTE ANAL FISSURE

Abstract

Objective: To evaluate the efficacy of 0.2% glyceryl trinitrate (GTN) paste as first line treatment in acute anal 
fissure with no severe side effects. 
Study Design: Randomized control trial.
Place and Duration of Study: Combined Military Hospital Kharian and Combined Military Hospital Malir
Pakistan from January 2008 to August 2010.
Patients and Methods: Patients presenting with acute anal fissure were randomized in 2 groups by using 
computer generated table. Group A received 0.2% GTN paste and group B received lignocaine gel twice daily 
in addition to high fiber diet, sitz bath and stool softeners. Pain scores on 100 mm Visual Analogue Scale, 
healing of fissure and side effects (headache and flatus incontinence) were noted at 0,2,4,6 and 8 weeks. 
Evolution to chronic anal fissure and recurrence rates (3 and 6 months) was also noted. Data was entered on 
SPSS 16.0 and p value was calculated. 
Results: Out of 161 patients, 109 patients (56 in group A and 53 in group B) completed the study. 
Demographical data was comparable in both the groups. Results were statistically significant (p <0.05 or less) 
in terms of complete healing of fissure and pain relief at each visit. Patient in group A had less recurrence 

Conclusion: Use of 0.2% GTN as first line treatment in acute anal fissure showed better pain relief fastened 
healing, less rec