A comparative study for management of fissure in ano with glycerin-trinitrate and lignocaine ointment: a randomized control trial

Authors

  • Kamlesh J. Galani Department of Surgery, C. U. Shah Medical College, Surendranagar, Gujarat, India
  • Ashwinkumar S. Gadhvi Department of Surgery, C. U. Shah Medical College, Surendranagar, Gujarat, India
  • Nidhi D. Shah Department of Surgery, C. U. Shah Medical College, Surendranagar, Gujarat, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20183244

Keywords:

Anal fissure, Glycerin-trinitrate, Lignocaine

Abstract

Background: Anal fissure is a very common benign anorectal disorder with significant morbidity among otherwise healthy individuals. Of all the patients coming to our OPD 15-20% have anal fissure. So there arises need to study the best and most compliant conservative treatment modality.

Methods: Study was randomized, prospective, observational and longitudinal including 200 patients of age group 18-60 equally divided in 2 groups. Group A given 0.2% GTN ointment and group B given lignocaine ointment.

Results: Better and early and sustained symptomatic relief was noted with GTN compared to lignocaine. 80% cases showed complete healing by 8 weeks with GTN compared to 52% healing with lignocaine. Headache was main side effect with GTN. Recurrence rate was high with lignocaine.

Conclusions: Topical GTN has a statistically and clinically significant success rate for fissure healing and pain improvement at 8 weeks compared to lignocaine ointment (80% vs. 52%). It came at the cost of clinically acceptable level of morbidity (headache).

References

Keighley M, Williams N. Surgery of the anus, rectum and colon. Elsevier Pub. 3rd edition. 2008;1:383.

Schouten WR, Briel JW, Auwerda JJ, De Graaf EJ. Ischemic nature of anal fissure. Br J Surg. 1996;83(1):63-5.

Nelson R. Non-surgical therapy for anal fissure. Cochrane database Syst Rev. 2006;18(4):CD003431.

Tøttrup A, Glavind EB, Svane D. Involvement of the L-arginine-nitric oxide pathway in internal anal sphincter relaxation. Gastroenterology. 1992 Feb 1;102(2):409-15.

Kennedy ML, Sowter S. Nguyen H, Lobowski DZ. Glyceryl trinitrate ointment for the treatment of chronic anal fissure: results of a randomized placebo controlled trial. Dis Colon Rectum. 1999;42:1000-6.

Haq Z, Rahman M, Chowdhury RA, Baten MA, Khatun M. Chemical sphincterotomy first line of treatment for chronic anal fissure. Mymensingh Med J. 2005 Jan;14(1):88-90.

Lund JN, Scholefield JH. A randomized, prospective, double blind, placebo-controlled trial of glyceryl trinitrate ointment in treatment of anal fissure. Lancet. 1997;349(9044):11-4.

Wemyss H, Haslam P, Hemingway D. The efficacy of glyceryl trinitrate ointment for anal fissure in clinical practice. Br J Surg. 1999;86(Suppl. 1):104.

Novell F, Novell-Costa F, Novell J. Topical glyceryl trinitrate in the treatment of anal fissure. Rev Esp Enferm Dig. 2004 Apr; 96(4):255-8.

Mustafa NA, Cengiz S, Turkyilmaz S, Yucel Y. Comparison of topical glyceryl trinitrate ointment and oral nifedipine in the treatment of chronic anal fissure. Acta Chir Belg. 2006;106(1):55-8.

Mann MS, Mishra R, Thomas S, Hadke NS. Randomized, double blind trial comparing topical nitroglycerine with xylocaine and proctosedyl in primary idiopathic chronic anal fissure. Ind J Gastroenterol. 2004;23(3):91-3.

Downloads

Published

2018-07-25

How to Cite

Galani, K. J., Gadhvi, A. S., & Shah, N. D. (2018). A comparative study for management of fissure in ano with glycerin-trinitrate and lignocaine ointment: a randomized control trial. International Journal of Research in Medical Sciences, 6(8), 2644–2647. https://doi.org/10.18203/2320-6012.ijrms20183244

Issue

Section

Original Research Articles