Effectiveness of Open Lateral Internal Sphincterotomy Versus Topical 0.2% Glyceryl Trinitrate for Chronic Anal Fissure Treatment

Background: Chronic anal fissures represent a prevalent anorectal pathology characterized by longitudinal mucosal tears in the anal canal. These lesions cause considerable patient morbidity through persistent pain, bleeding, and functional impairment. This comparative study evaluated the therapeutic outcomes of open lateral internal sphincterotomy versus topical 0.2% glyceryl trinitrate (GTN) in managing chronic anal fissures. Methods: A prospective comparative study was conducted in the Department of Surgery at Jinnah Hospital, Lahore, over six months. Sixty patients diagnosed with chronic anal fissures were randomized into two treatment arms: Group A received conservative management with topical 0.2% GTN ointment applied digitally using gloved fingers, while Group B underwent open lateral internal sphincterotomy. Treatment outcomes and complications were systematically evaluated and compared between groups. Results: Complete fissure healing was achieved in 15 patients (50%) in Group A treated with GTN, compared to 28 patients (93.3%) in Group B who underwent surgical intervention. Post-operative complications included flatal incontinence in 2 patients (6.6%) in the surgical group, while no incontinence was observed in the conservative treatment group. Conclusion: Although open lateral internal sphincterotomy demonstrated superior healing rates (93.3% vs 50%), the associated risk of fecal incontinence warrants careful consideration. Topical 0.2% GTN offers a safer first-line approach with acceptable efficacy, while surgical intervention should be reserved for cases where conservative management fails. The choice of treatment should be individualized based on patient factors and the severity of symptoms, balancing therapeutic efficacy against potential complications. DOI: https://doi.org/10.59564/amrj/03.02/008