Role of glyceryl trinitrate topical ointment in the management of chronic anal fissure

Surgery has always been the treatment of choice for chronic anal fissure. however the results achieved with the use of topical ointments like glyceryl trinitrate have also been encouraging. a prospective study of 89 consecutive patients with chronic anal fissure treated with 0.2% topical glyceryl trinitrate ointment for a median duration of 9 weeks(range 2-16) weeks was performed. sixty three patients (71%) experienced healing of the fissure after using the topical application for a period of 2-5 weeks. another 14 (15%) patients who did not respond to the therapy,got relieved after a duration of another 4-5 weeks. so overall 77(86%) patients got better with this therapy. nine patients failed to follow up (10%). the remaining three patients requested for surgical option as they were reluctant to wait for the affects of the topical ointment. headache and local irritation were the two main side effects reported by the patients.