Comparative Study for Comparison between Topical Glyceryl Trinitrate (0.25%) and Lateral Anal Sphincterotomy for Fissure in Ano

Abstract Introduction: Anal fissures are small tears in the anal canal often treated with topical glyceryl trinitrate (GTN) or lateral internal sphincterotomy (LIS). While GTN promotes healing by relaxing the sphincter, LIS is more effective in chronic cases, reducing pressure and improving blood flow to the fissure. This study aimed to compare the efficacy of topical glyceryl trinitrate with that of lateral anal sphincterotomy for anal fissures. Methods: This randomised controlled trial was conducted on 48 patients at the Government Thiruvarur Medical College and Hospital over 12 months. All patients aged > 18 years who presented with anal fissures in the General Surgery and TAEI ward at the Thiruvarur Medical College and Hospital were included in this study. Significance was defined as P values less than 0.05 using a two-tailed test. Results: The age distribution between the groups showed no significant difference (p = 0.553), with most patients aged 36-45 years in both groups A (33.3%) and B (33.3%). Gender distribution was also similar (p = 0.386), with Group A having 45.8% females compared to 58.3% in Group B. Bleeding incidence was high in both groups (83.3% in Group A, 79.2% in Group B, p = 0.712), and constipation was slightly more prevalent in Group A (83.3% vs. 70.8%, p = 0.303). Pain relief was significantly better in Group B, with lower VAS scores at 1 week (3.54 vs. 5.88, p < 0.0001) and 6 weeks (0.96 vs. 2.58, p < 0.0001). Delayed healing and headache were more common in Group A differences were not statistically significant (p = 0.074). Conclusion: Lateral anal sphincterotomy is more effective than topical Glyceryl Trinitrate in treating chronic anal fissures, offering faster healing and greater pain relief. Although Glyceryl Trinitrate is a valid non-surgical option, its effectiveness may be hindered by delayed healing and side effects such as headaches, making sphincterotomy the preferred treatment for severe cases.