title: A prospective, randomized, double-blind, placebo-controlled trial of glyceryl-trinitrate ointment in the treatment of children with anal fissure.
abstract: BACKGROUND
  Anal fissure in children usually is treated by sitz baths, stool softeners, and analgesic ointments. However, some cases are intractable to the treatment. In recent years, it has been reported that nitric oxide donors such as local glyceryl-trinitrate (GTN) ointment causes a reversible chemical sphincterotomy. Although the GTN ointment can be an alternative therapy for adult cases, it has not yet been studied in the children who suffer from anal fissure.
  
  
  METHODS
  Sixty-five children with anal fissure were divided randomly into 3 groups. Each group received double-blinded a topical ointment that contained either 0.2% GTN, 10% lidocaine, or placebo. These ointments were applied to the lowest part of the anal canal twice daily. Patients were periodically reviewed, and the study was ended after 8 weeks.
  
  
  RESULTS
  Complete healing of the fissure occurred in 26 of 31 (83.9%) patients treated with GTN, 7 of 14 (50%) patients treated with lidocaine, and 6 of 17 (35.2%) treated with placebo. In 29 of 31 (93.5%) GTN-treated patients, a total relief of symptoms was observed, whereas this occurred in 7 of 14 (50%) treated with lidocaine and 6 of 11 (35.3%) in the placebo group. The differences between the study group and control groups were highly statistically significant (P < .001).
  
  
  CONCLUSIONS
  The majority of children suffering from anal fissure will be cured and have relief of symptoms after topical application of GTN ointment to the anal canal.
authors.affiliation: Department of Pediatric Surgery, Gülhane Military Medical Academy, Ankara, Turkey.
authors.forename: B
authors.initials: B
authors.lastname: Tander
authors.forename: A
authors.initials: A
authors.lastname: Güven
authors.forename: S
authors.initials: S
authors.lastname: Demirbağ
authors.forename: Y
authors.initials: Y
authors.lastname: Ozkan
authors.forename: H
authors.initials: H
authors.lastname: Oztürk
authors.forename: S
authors.initials: S
authors.lastname: Cetinkurşun
mesh_terms: D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D005260:Female; D005401:Fissure in Ano / Q000188:drug therapy*; D006801:Humans; D007223:Infant; D008297:Male; D005996:Nitroglycerin / Q000627:therapeutic use*; D009824:Ointments; D011446:Prospective Studies; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000627:therapeutic use*
chemical_list: D009824:Ointments; D014665:Vasodilator Agents; D005996:Nitroglycerin