Abstract
Background
Anal fissure is the most common anal disease in children. In the past few decades,
the understanding of its pathophysiology has led to a progressive reduction in invasive
procedures in favor of conservative treatment based on stool softeners and the relaxation
of the anal sphincter. This randomized controlled study assessed the safety and efficacy
of nitroglycerine (NTG) ointment in the treatment of pediatric anal fissure, which
had not yet been proved.
Patients and methods
An unequal randomized controlled study included 105 pediatric patients with anal fissure
who had presented to the private and outpatient clinics of the Central Teaching Hospital
of Pediatrics during the period from February 2015 to May 2016. The control group
consisted of 70 patients. Both groups were treated with classical conservative therapy
of sitz bath, stool softener, and local anesthetic. In the second group, chemical
sphincterotomy with 0.2% NTG ointment was used in 35 patients, and was applied at
the anal canal twice daily for 8 weeks. The primary outcomes of symptomatic improvement and healed fissure, as well
as side effects, were analyzed.
Results
The average age of patients was 2 years (range, 4 months to 5 years). Patients in the NTG group had 77% symptomatic relief and 60% healed fissure
compared to the control group, which had 54% and 32.8% respectively. All were statistically
significant. No serious adverse effects were noticed during the treatment period.
Conclusion
The use of 0.2% NTG ointment is an effective therapy for anal fissure in children
in terms of good healing rate and rapid symptom relief, but it has the drawback of
a long treatment period, making patient compliance more difficult, in addition to
the problems of tolerance and recurrence.
Type of study
Prospective randomized controlled study (treatment study).
Level of evidence
Type 2.
Key words
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Article info
Publication history
Published online: April 13, 2017
Accepted:
April 3,
2017
Received in revised form:
February 26,
2017
Received:
November 1,
2016
Footnotes
☆Conflict of interest: nil.
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
