Azeem Hashmat, Tahira Ishfaq.
Chemical versus surgical Sphincterotomy for chronic fissure in ano.
J Coll Physicians Surg Pak Jan ;17(1):44-7.

Objective: To evaluate the efficacy and costs of chemical (topical glyceryl trinitrate ointment) versus lateral internal sphincterotomy for the treatment of chronic anal fissure. Design: A quasi-experimental study. Place and Duration of Study: This study was conducted at D.H.Q. /Allied Hospital, Faisalabad from November 2001 to October 2003. Patients and Methods: Out of 74 patients, topical treatment was applied to 46. Eighteen patients never followed this modality of treatment so were excluded from the study. The remaining 28 patients applied 0.2% glyceryl trinitrate ointment on their anal verge thrice-a-day for two months. The patients in urgency due to pain or refused topical modality were treated by surgical sphincterotomy. Twenty-eight patients were allocated to undergo surgical sphincterotomy. The patients were followed-up and the extent of improvement in presenting symptoms, side effects, complications and costs of these modalities were noted on the questionnaires. Results: Chemical sphincterotomy relieved symptoms only in 18 (64.3%) patients while surgical sphincterotomy relieved 28 (100%) patients. In the former, recurrence occurred in 6 (33.3%) patients, but in the later group incontinence of flatus/ faeces was present in 18 (64.3%) at first week which resolved by eighth weeks. Wound related complications in 4 (14.2%) cases were noted. Average costs of treatments excluding hospital expenditures were Rs. 164 and Rs. 1244 respectively. Conclusion: Topical modality proved to be cost-effective and non-invasive than the surgical modality, but later was superior regarding healing of anal fissures.

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