Nadia Khitab, Nisar Ahmad, Abid Hussain, Mahmud Aurangzeb


Background: Anal fissure disease is a commonly distressing disease in both genders. Surgery remains a corner stone in the management of anal fissure through the ages but currently, a more conservative approach in the form of medical treatment is more advocated both in acute and chronic anal fissure. The present study describes the use of Glyceryl trinitrate (GTN) in the treatment of chronic anal fissure.

Methods: It is a descriptive study that was conducted in the department of surgery Unit ‘D’ of Khyber teaching Hospital Peshawar from May till December 2017. A total of 60 consecutive patients with chronic anal fissure was treated with 0.2% GTN ointment applied three times a day to the anus. These patients were followed at 2 and 6 weeks to assess symptoms control and adverse effects. Data was collected on Proforma and was analysed on SPSS.

Results: By 14 days of treatment, 8 patients were pain-free, While 30 out of them were pain-free by end of 6 weeks of treatment. Out of 18 patients, who presented with bleeding per rectum (P/R), 14 were still having bleeding P/R by the end of 2 weeks that improved to 6 by the end of 6 weeks. And 8 patients were in severe pain even by end of 6 weeks. None of the patients had to discontinue treatment with GTN due to side effects.

Conclusions: The use of GTN ointment in the treatment of chronic anal fissure is not effective. Or Symptomatic relief occurred at a slower pace in patients receiving topical 0.2% Glyceryl trinitrate ointment.


Anal fissure, Glyceryl trinitrate, nitric oxide (NO)

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