title: Disappointing results of glyceryl trinitrate ointment in the treatment of chronic fissure-in-ano in a district general hospital.
abstract: OBJECTIVE
  The recent introduction of glyceryl trinitrate ointment (GTN) has greatly changed the management of chronic fissure-in-ano. We have investigated the results obtained from this new treatment and the consequent alterations to surgical practice.
  
  
  METHODS
  All patients who presented with chronic fissure-in-ano from March 1997 to March 1998 were treated with GTN ointment and prospectively evaluated until healing or lateral internal sphincterotomy. Long-term follow up was obtained using a telephone questionnaire.
  
  
  RESULTS
  Forty-five patients were treated with GTN ointment. Twenty-two (49%) were healed initially, but 10/22 (45%) recurred within 36 weeks. Twelve (27%) patients were healed for the duration of this study. Twenty-six (58%) patients complained of headache, of whom five (11%) were forced to abandon treatment. In comparison with the previous year, rates of lateral internal sphincterotomy reduced by 24%.
  
  
  CONCLUSIONS
  GTN is a useful adjunct to the treatment of chronic anal fissure, but sphincterotomy remains the mainstay of treatment.
authors.affiliation: Department of General Surgery, West Middlesex University Hospital NHS Trust, Isleworth, UK.
authors.lastname: Pitt
authors.lastname: Dawas
authors.lastname: Dawson