Percutaneous posterior tibial-nerve stimulation, perianal application of glyceryl trinitrate ointment, or closed lateral internal sphincterotomy in treatment of chronic anal fissure

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Abstract

Background
Chronic anal fissures are longitudinal tear in the anoderm below the dentate line, typically occurring in the midline, with visible sphincter fibers at the fissure base, anal papillae, sentinel piles, and indurated margins. The gold-standard method of treatment is lateral internal sphincterotomy, which can be done by either open or closed technique. Medical sphincterotomy refers to pharmacological manipulation of anal sphincter tone as an alternative modality to surgery.
Objective
To compare the efficacy of treatment among patients receiving glyceryl trinitrate (GTN) treatment for chronic anal fissure with that among patients receiving percutaneous posterior tibial-nerve stimulation and those undergoing closed lateral internal sphincterotomy.
Patients and methods
In total, 120 patients were randomly allocated into three groups: 40 patients treated with percutaneous posterior tibial-nerve stimulation, 40 patients treated with GTN ointment, and 40 patients treated with closed lateral internal sphincterotomy.
Results
This study showed that treatment with percutaneous posterior tibial-nerve stimulation had led to complete healing in 27.5% of patients in posterior tibial-nerve stimulation group, 70% of patients in the GTN group, and 95% of patients in closed lateral internal sphincterotomy group.
Conclusion
Closed lateral internal sphincterotomy remains the gold standard for treatment of chronic anal fissure.

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