Haseeb Ul Hassan, Ziyad Kayani, Muhammad Aamir, Maryum Saleem Raja, Irum Gillani


Background: Anal fissure is a longitudinal or oval tear in the anal mucosa in distal anal canal. Chronic anal fissure can be treated conservatively with medications, including 0.2% glyceryl trinitrate (GTN) rectal ointment or surgically by internal lateral sphincterotomy (ILS). The objective of this study was to compare the efficacy of LIS vs. 0.2% GTN rectal ointment in healing of anal fissure in population of Muzaffarabad division, Azad Kashmir.

Materials & Methods: This randomized controlled trial was carried out in Department of Surgery, Abbas Institute of Medical Sciences, Muzzafarabad, Azad Kashmir from June 2021 to Feb 2022. Ninety patients were equally randomly allocated by toss to control group using medical treatment by 0.2% GTN rectal ointment and experimental group for surgical intervention by lateral internal sphincterotomy. Sex (men/women) and age groups (≤40 years/>40 years) were two matching variables, while healing of anal fissure was research variable, all being nominal. McNemar chi-square test was used for hypothesis testing.

Results: Out of 45 patients in control/GTN group, 23 (51.11%) had healed anal fissures and 22 (48.89%) had not. Out of 45 patients in experimental/LIS group, 35 (77.78%) patients had healed anal fissures and 10 (22.22%) patients had not. Mc-Nemar chi-square test rejected null hypothesis (p=.0139), showing that LIS has significantly higher efficacy than 0.2% GTN in healing of chronic anal fissure.

Conclusion: In our population, lateral internal sphincterotomy showed significantly higher efficacy than 0.2% GTN rectal ointment in healing of chronic anal fissure.


Lateral Internal Sphincterotomy; Anal Canal; Rectum; Defecation.

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DOI: https://doi.org/10.46903/gjms/20.03.1195


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