THE TREATMENT EFFICACY OF MEDICAL SPHINCTEROTOMY WITH GLYCEROL TRINITRATE ON ACUTE ANDCHRONIC ANAL FISSURES

Abstract

This study was planned to compare local application of nitric oxide donor ointment and anesthetic gel for the reduction of anal resting, squeeze pressures and also healing rates of acute and chronic anal fissures, Patients with anal fissures were divided into two (A and B) groups. There were 17 patients (acute10, chronic 7) in each groups. They were received respectively topical 2% nitric oxide donor ointment and 5% anesthetic lignocaine gel three timesa day during the four weeks period. Anal resting pressure, squeeze pressure and clinical examination were done a weekly intervals before and during the therapy periods. After one week treatment period, mean anal resting pressure was significantly reduced with topical nitric oxide donor ointment application in group A, but similar results were not observed in group B. Anal squeeze pressures were not significantly reduced by local applications in two groups. The healing rates were obtained 80 percent in acute (n=8)(p=0.001), 29 percent in chronic(n=2)(p=0.172)in group A and 60 percent in acute (n= 6) (p= 0.005), 0 percent in chronic (n= 0) in group B after four weeks therapy period. In this study, topical nitric oxide donor application causes to anal canal resting pressure reduction and improve vascular perfusion of anal fissure tissue. Patients were undergone operation for chronic anal fissure that resistant to medical management can be reduced with topical nitric oxide donor application.