Disappointing results of glyceryl trinitrate ointment in the treatment of chronic fissure-in-ano in a district general hospital

Objective The recent introduction of glyceryl trinitrate ointment (GTN) has greatly changed the management of chronic fissure‐in‐ano. We have investigated the results obtained from this new treatment and the consequent alterations to surgical practice. Patients and methods All patients who presented with chronic fissure‐in‐ano from March 1997 to March 1998 were treated with GTN ointment and prospectively evaluated until healing or lateral internal sphincterotomy. Long‐term follow up was obtained using a telephone questionnaire. Results Forty‐five patients were treated with GTN ointment. Twenty‐two (49%) were healed initially, but 10/22 (45%) recurred within 36 weeks. Twelve (27%) patients were healed for the duration of this study. Twenty‐six (58%) patients complained of headache, of whom five (11%) were forced to abandon treatment. In comparison with the previous year, rates of lateral internal sphincterotomy reduced by 24%. Conclusion GTN is a useful adjunct to the treatment of chronic anal fissure, but sphincterotomy remains the mainstay of treatment.