Chemical Sphincterotomy by Topical Nitroglycerin 0.4% Ointment for Anal Fissure, a Retrospective Study

Background Anal fissure is one of the most common benign proctological conditions, significantly affecting patients’ quality of life. Approximately 10% of patients presenting to specialty clinics report symptoms of this disease. Anal fissures are classified as acute or chronic. The exact pathogenesis remains unclear, though several contributing factors have been proposed. Diagnosis is primarily clinical, and treatment ranges from conservative management to various surgical interventions. Topical glyceryl trinitrate (GTN) ointment is among the conservative treatment options. Objectives This prospective study aimed to evaluate the efficacy of topical 0.4% GTN ointment as a first-line treatment for both acute and chronic anal fissures. Patients and Methods: This study was conducted in the General Surgery outpatient clinic in Erbil, Kurdistan Region, Iraq, between 19th August 2022 and 11th August 2023. All patients diagnosed with anal fissure were prescribed 0.4% topical GTN ointment, along with specific advice to manage reversible risk factors. Response to treatment was assessed over a six-month follow-up period. Results Of 81 patients included, 62 (76.54%) were male and 19 (23.46%) were female, with ages ranging from 14 to 60 years (mean ± SD: 31.64 ± 5.66). Acute fissures were diagnosed in 63 cases (77.77%) and chronic fissures in 18 cases (22.23%). At six months, the overall cure rate was 65.43% (53 cases), with 71.43% for acute fissures and 44.44% for chronic fissures. No significant drug-related side effects were observed. Conclusion Topical 0.4% GTN ointment is an effective treatment for anal fissures, particularly in acute cases, offering a non-invasive, safe, and cost-effective therapeutic option.