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[Intra-anal application of isosorbide dinitrate in chronic anal fissure]
W R Schouten1, J W Briel, J J Auwerda
1Afd. Heelkunde, Academisch Ziekenhuis Rotterdam-Dijkzigt.
Objective:
To evaluate the effect of intra-anal application of isosorbide dinitrate on the healing rate of chronic anal fissure.
Design:
Prospective, descriptive.
Setting:
Outpatient clinic of the department of Surgery, University Hospital Dijkzigt, Rotterdam.
Method:
Sixteen patients with chronic (more than three months' duration) anal fissure were treated by intra-anal application of isosorbide dinitrate ointment every 3 hours, except during the night. The maximal duration of therapy was 12 weeks. Every three weeks the following aspects were investigated: clinical symptoms, side-effects and fissure healing.
Results:
All patients experienced mild and transient headache shortly after the beginning of the treatment. At three weeks the fissure-related pain was resolved in all patients. At 6, 9 and 12 weeks the fissure was completely healed in 9, 11 and 15 patients respectively.
Conclusion:
The majority of chronic anal fissures can be treated effectively by local application of isosorbide dinitrate. This new and simple treatment modality appears to be an attractive alternative to the currently available surgical procedures.