Glyceryl trinitrate ointment (0.25%) and anal cryothermal dilators in the treatment of chronic anal fissures.
BACKGROUND
Chronic anal fissure is a common benign disorder; for this condition, lateral internal sphincterotomy is the "gold standard" of treatment. Alternative medical treatments have not proven to be as effective as left lateral internal sphincterotomy.


OBJECTIVE
This randomized trial was designed to compare the use of 0.25% glyceryl trinitrate ointment and anal cryothermal dilators with the use of 0.4% glyceryl trinitrate ointment alone in the treatment of chronic anal fissures.


METHODS
Between 1 June 2006 and 31 December 2007, 60 consecutive patients who were suffering from chronic anal fissures were randomized into two groups. The patients in group A (n = 30) were treated with 0.25% glyceryl trinitrate ointment and anal cryothermal dilators twice daily, and those in group B (n = 30) were treated with 0.4% glyceryl trinitrate ointment alone twice daily. The treatment was administered to the patients in each group for 6 weeks, and all patients were examined 7 weeks after the start of the trial.


RESULTS
Prior to treatment, the symptoms and the measurements of anal pressure were similar in both groups. At 7 weeks, the maximum resting pressure was significantly lower in group A (P < 0.05), in which 86.6% of the patients were asymptomatic in comparison with 73.3% of the patients in group B. After 1 year of follow-up, 25 patients (83.3%) in group A and 18 patients (60%) in group B presented no recurrence of symptoms (P < 0.05)


CONCLUSIONS
Treatment of chronic anal fissures with 0.25% glyceryl trinitrate ointment and anal cryothermal dilators was more effective than the administration of 0.4% glyceryl trinitrate ointment alone.
General Surgery Department, S. Maria dei Battuti Hospital, Via Brigata Bisagno, 4, 31015, Conegliano (Treviso), Italy. dr.schianodivisconte@tiscali.it
Michele
M
Schiano di Visconte
Gabriele
G
Munegato
D000287:Administration, Topical; D000293:Adolescent; D000328:Adult; D001003:Anal Canal / Q000187:drug effects*; D002908:Chronic Disease; D017679:Cryotherapy / Q000295:instrumentation*; D004106:Dilatation / Q000295:instrumentation*; D005260:Female; D005401:Fissure in Ano / Q000175:diagnosis / Q000628:therapy*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008365:Manometry; D005996:Nitroglycerin / Q000627:therapeutic use*; D009824:Ointments; D010147:Pain Measurement; D017060:Patient Satisfaction; D011336:Probability; D011446:Prospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology; D055815:Young Adult
D009824:Ointments; D005996:Nitroglycerin