A Study to Determine the Nitroglycerin Ointment Dose and Dosing Interval That Best Promote the Healing of Chronic Anal Fissures

Bailey, H. Randolph; Beck, David E.; Billingham, Richard P.; Binderow, Sander R.; Gottesman, Lester; Hull, Tracy L.; Larach, Sergio W.; Margolin, David A.; Milsom, Jeffrey W.; Potenti, Fabio; Rafferty, Janice F.; Riff, Dennis; Sands, Lawrence R.; Senagore, Anthony J.; Stamos, Michael J.; Yee, Laurence F.; Young‐Fadok, Tonia M.; Gibbons, Robert D.

doi:10.1007/s10350-004-6392-9

Cited by 85 publications

(54 citation statements)

References 37 publications

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“…In our study, 15 patients (14.6 %) discontinued the treatment because of headache (12.6 %) and local discomfort (2 %). This percentage is similar to other studies that used different GTN concentration [25][26][27].…”

Section: Discussionsupporting

confidence: 90%

Role of 0.4% glyceryl trinitrate ointment after haemorrhoidectomy: results of a prospective randomised study

Franceschilli

D’Ugo

Luca

et al. 2012

Int J Colorectal Dis

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Introduction Conventional haemorrhoidectomy (CH) is well known to cause significant post-operative pain and delayed return to daily activities. Both surgical wounds and sphincterial apparatus spasms are likely responsible for the pain. In this study, we evaluated the role of glyceryl trinitrate ointment (GTN) in reducing post-operative pain, ameliorating wound healing and recovery after CH. Patients and methods Between 01/08 and 12/11, 203 patients with symptomatic haemorrhoids were enrolled in the study and received (103 patients) or not (100 patients) 0.4 % GTN ointment for 6 weeks after surgery. Pain was assessed using a 10-cm linear visual analogue scale (VAS). Data on postoperative pain, wound secretion and bleeding, return to normal activities and complications were recorded. Data were analysed using Fisher's exact and Mann-Whitney tests. Results GTN-treated group experienced significantly less pain during the first week after surgery (p< 0.0001). This difference was more evident starting from postoperative day 4 (p<0.0001). A significant higher percentage of untreated patients experienced severe pain (mean VAS score>7) (10 % vs 31 %). There were significant differences in terms of secretion time (p00.0052) and bleeding time (p00.02) in favor of GTN. In addition, the duration of itching was less in the GTN group (p00.0145). Patients treated with GTN were able to an early return to daily activities compared to untreated (p < 0.0001). Fifteen GTN-treated patients (14.6 %) discontinued the application because of local discomfort and headache. Conclusions GTN ointment enhances significantly postoperative recovery, reducing pain in terms of duration and intensity. This effect might be secondary to a faster wound healing expressed by reduced secretion, bleeding and itching time.

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Section: Discussionsupporting

confidence: 90%

Role of 0.4% glyceryl trinitrate ointment after haemorrhoidectomy: results of a prospective randomised study

Franceschilli

D’Ugo

Luca

et al. 2012

Int J Colorectal Dis

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“…Psyllium may have exerted its effect by preventing the formation of hard stool causing mechanical trauma responsible for the development of chronic anal fissure and diarrheal attacks. Recent studies have emphasized that topical nitroglicerin at 0.04% concentration 2×1.5 mg is the most efficient dose in treatment of chronic anal fissure [28,29]. In a study carried out by Ergun et al [30] on 568 pharmacists, it was shown that only 24 (%4) of the pharmacists prepared topical nitroglicerin prescription and %0.4 nitroglicerin content was not found exactly at this ratio in preparations.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Lateral Internal Sphincterotomy with Topical Nitroglycerine Treatment in Patients with Chronic Anal Fissure: A Prospective Randomised Study

Yetışır¹

2012

Surgery Curr Res

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Aim: Lateral Internal Sphincteromy (LIS) is considered as gold standard in the treatment of chronic anal fissure. However, LIS has complications such as gas and stool incontinence. The aim of the present study was to compare the results of LIS and 0.4% topical nitroglicerin treatment in patients with chronic anal fissure.Method: 150 patients with Chronic Anal Fissure were prospectively randomised into two Groups of 75 subjects in each. Group I underwent LIS and Group 2 was administered topical nitroglicerin. All patients were given high fibre diet and phsyllium diet before and after the treatment. After follow up period, two Groups were compared in terms of postoperative complications, recurrence rates, loss of work days and patient satisfaction.

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“…In fact, up to 20% of patients cease GTN therapy due to the severity of their headaches. [30], [31], [32], [33] A 2%GTN ointment applied twice to the anoderm for 6 weeks results in a complete healing in 98% of patients. [6] In another study, Topical diltiazem ointment was used as an agent for chemical sphincterotomy for chronic anal fissure.…”

Section: Topical Nitratesmentioning

confidence: 99%

“…[31] Nonetheless, lateral internal sphincterotomy still stands as the surgical treatment of choice for refractory anal fissures and may be offered without pharmacologic treatment failure according to the practice parameters by the American Society of Colon and Rectal Surgeons. [8] Reports of sphincterotomy for various anal pathologies probably date back to the 1700s.…”

Section: Division Of Internal Anal Sphinctermentioning

confidence: 99%

Anal Fissure Revisited : A Systematic Review

Singh¹,

Chandrakar²,

Agrawal³

et al. 2015

jemds

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Anal fissure is one of the most common anorectal problems. Anal fissure is largely associated with high anal sphincter pressures and most treatment options are based on reducing anal pressures. There are many options to treat chronic fissures in ano. Some of them are non-surgical while the others are surgical. The efficacy claimed by each of the prevalent method is very high but the inconsistencies and contraindications are equally strong. To date, lateral sphincterotomy has been favoured by most of the proctologists, because it is the least extensive surgical procedure and is offering a long lasting relief in sphincter spasm. Various management technique are reviewed in this article along with Advancement flap for anterior fissure and a new method combining the age-old technique of Lord's manual dilatation followed by radio surgery is also highlighted along with their complications. The addition of radio surgery is found useful for refreshing the edges of the fissure and to tackle pathologies namely sentinel pile, small internal piles or hypertrophied anal papillae often found associated with chronic fissures. Revisiting the trends of treatment of chronic anal fissures, the most preferred options are the manual dilatation with radio surgery and the subcutaneous lateral anal sphincterotomy. Both methods are easy to perform, have negligible complications and no special setup is needed, except the radio surgical unit, in case of the first procedure.

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A Study to Determine the Nitroglycerin Ointment Dose and Dosing Interval That Best Promote the Healing of Chronic Anal Fissures

Abstract: Nitroglycerin ointment did not alter healing but significantly and rapidly reduced the pain associated with chronic anal fissures.

Cited by 85 publications

References 37 publications

Role of 0.4% glyceryl trinitrate ointment after haemorrhoidectomy: results of a prospective randomised study

Role of 0.4% glyceryl trinitrate ointment after haemorrhoidectomy: results of a prospective randomised study

Comparison of Lateral Internal Sphincterotomy with Topical Nitroglycerine Treatment in Patients with Chronic Anal Fissure: A Prospective Randomised Study

Anal Fissure Revisited : A Systematic Review

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