Comparison of Lateral Internal Sphincterotomy and GTN Gel for management of Chronic anal fissure: A Randomized Controlled Trial

Background:Anal fissure is quite a common and painful condition which occurs in all age groups and in both genders. The treatment options are numerous; however, broadly it may be surgical and nonsurgical. Among surgical, most commonly performed procedure is Lateral Internal Sphincterotomy (LIS), while among non-surgical most common in use of Glycerin Trinitrate gel (GTN) Aim:To compare the successfulness of treatment with GTN and LIS in patient with chronic anal fissure. Methods:This randomized controlled trial was conducted at AllamaIqbal memorial Trust Hospital Gt Road, Gujranwala Medicare International Hospital Gill Road Gujranwala and Services Institute of Medical Sciences Lahore over a period of 3 years, from 2014 to 2016. All the patients presenting with chronic anal fissure with the age of 18-60 years were included in this study. They were randomly divided into two groups by computer generated numbers: group A (LIS) and group B (GTN). Patients in group A underwent LIS by consultant surgeons on elective list in a standard fashion. Patients in group B received 2% GTN gel. All patients in both groups were assessed after 8 weeks of start of treatment or intervention. All the data were analyzed using SPSS version 20. Results:A total of 60 patients (30 in each group) were included in this study. All the demographic details were almost comparable in both groups. Regarding the position of fissure, most common position was posterior in both groups. Treatment was successful in all patients (100%) in patients in group A while it was successful in 22 patients (73.33%) in group B (P <0.05). One patient in group A had incontinence for flatus, while in group B, headache was reported by all and 6 patients discontinued the treatment with GTN due to severe headache. Conclusion:We conclude that LIS is better than GTN and it may be considered as gold standard treatment for anal fissure particularly in chronic cases. However, the importance of conservative and non-surgical management regimens can’t be negated.