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BioMed Research International
Volume 2014, Article ID 964942, 5 pages
Clinical Study

Maintenance Therapy with Partially Hydrolyzed Guar Gum in the Conservative Treatment of Chronic Anal Fissure: Results of a Prospective, Randomized Study

1Surgery Department, Second University of Naples, Piazza Miraglia 2, 80138 Napoli, Italy
2Radiology Department, Second University of Naples, Piazza Miraglia 2, 80138 Napoli, Italy
3“Villa delle Querce” Hospital, Via Battistello Caracciolo 48, 80136 Napoli, Italy

Received 4 February 2014; Accepted 28 May 2014; Published 25 June 2014

Academic Editor: Toshimi Chiba

Copyright © 2014 Antonio Brillantino et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Purpose. This study was designed to evaluate the role of maintenance therapy with partially hydrolyzed guar gum (PHGG) after topical application of glyceryl trinitrate (GTN) in the conservative treatment of chronic anal fissure (CAF). Methods. From all the patients with CAF observed during the study period, 165 subjects with healed CAF after standard therapy with topical GTN 0.4% ointment were randomized to receive (group II) or not (group I) maintenance therapy with PHGG for 10 months. Clinical and manometric followup was carried out 6 and 12 months after treatment. Results. At six-month followup, median visual analogue scale score was significantly higher in group I if compared with group II. The success and recurrence rate at 12-month followup were, respectively, 38.3% (28/73) in group I versus 58.5% (41/70) in group II (; Fisher’s exact test) and 30.2% (13/43) in group I versus 14.5% (7/48) in group II (; Fisher’s exact test). Conclusion. The maintenance therapy with PHGG in patients with healed CAF after chemical sphincterotomy by topical application of GTN 0.4% ointment seems associated with a significant reduction of recurrence rate and with a significant increase of success rate at 12-month followup.