Cut or paste? The use of glyceryl trinitrate paste in the treatment of acute and chronic anal fissure.
BACKGROUND
Anal fissure unresponsive to conservative measures such as stool softeners frequently requires surgical intervention. The present study describes the use of glyceryl trinitrate (GTN) in the treatment of acute and chronic anal fissure.


METHODS
Eighteen consecutive patients with anal fissure were treated with 0.5% GTN paste in soft white paraffin applied twice daily to the anus. These patients were followed at regular intervals to assess symptom control, rate of healing, adverse effects and recurrence rate.


RESULTS
Two patients were lost to follow-up. Twelve of the remaining 16 were cured. Of these, symptomatic relief was obtained for most within 2 days, and for all within 1 week. No patient required cessation of treatment due to adverse effects. Treatment failed in four of 16 patients. Two of these patients subsequently underwent successful surgical procedures, and two patients (while not completely cured) had sufficient symptomatic relief to decide against surgery.


CONCLUSIONS
The use of GTN paste in the treatment of acute and chronic anal fissure may be a safe and effective modality that can be considered as first-line treatment for this condition.
Ward
D I
DI
Colorectal Unit, University of Queensland, Princess Alexandra Hospital, Brisbane, Australia. dave_ward@USA.net
Miller
B J
BJ
Schache
D J
DJ
Cohen
J R
JR
Theile
D E
DE
D000208:Acute Disease; D002908:Chronic Disease; D003131:Combined Modality Therapy; D005401:Fissure in Ano / Q000188:drug therapy* / Q000601:surgery; D006801:Humans; D005996:Nitroglycerin / Q000008:administration & dosage*; D009824:Ointments; D014665:Vasodilator Agents / Q000008:administration & dosage*
D009824:Ointments; D014665:Vasodilator Agents; D005996:Nitroglycerin