Chronic anal fissure is common perianal condition. Surgical sphincterotomy is very successful at healing these fissures but requires an operation with associated morbidity. Temporary reduction in sphincter tone can be achieved on an outpatient basis by applying a topical nitric oxide donor (glyceryl trinitrate) 0.4% twice daily for four week duration. A total of 120 patients with chronic anal fissure were collected randomly from Kirkuk general hospital and private surgerical clinic prospectively from September 2014 till December 2015. Whether pharmacological treatment or surgical treatment is the best first line options in the treatment of chronic anal fissure will be the main issue of this study. Results: A total of 120 patients with chronic anal fissure were enrolled in this study. All patients received (GTN) as first line therapy for 4 week. 100 patients were able to complete medical treatment, while the remaining twenty patients were unable to complete medical treatments due to side effects caused by the drug. Regarding medical treatment outcome: 65 of patients(from total 100) (45 male, 23 female) achieved complete recovery and only 35 of patients (23 male, 12female) failed to reach complete recovery even after 4 week of treatment and undergoing sphincterotomy as second line options. About 91%(n=59) of patients achieved complete recovery within 2-3 week from the start of (GTN), and 9% (n=6) of patients recovered with complete 4 week administration of (GTN). Conclusions: digital application of glyceryl trinitrate as first line therapy for chronic anal fissure was the best choice for majority of patients, with treatment course of 4 week.

anal fissure, innovation therapy, glyceryl trinitrate, lateral internal sphincterotomy, Kirkuk