| Abstract: | Objective To create a protocol for colorectal nurse‐led management of patients with idiopathic anal fissure. Patients and methods The outcome of 135 patients with anal fissure presenting over a 3‐year period to one (half time equivalent) Colorectal Surgeon in a District General Hospital, in whom initial management was centred on the use of 0.2% glyceryl trinitrate (GTN) was audited. Patients unavailable for complete follow‐up, those with fissures of a specific aetiology and those in whom GTN was contra‐indicated were excluded. 44% of patients were initially seen by a suitably trained and supported Nurse Practitioner (NP). Results Succes rates for fissure healing with 0.2% GTN were similar to those reported in other studies. There were no differences in outcome between those patients managed by the NP and those managed by the Consultant/Specialist Registrar. As a result of the audit, a treatment protocol for use by Nurse Practitioners (as well as surgical staff), a patient information leaflet, and policy documents relating to NP management of anal fissures have been developed. Conclusion It has been possible to construct a treatment protocol allowing rational management of patients with anal fissure by suitably trained and supported nurse specialists within their own clinic. This may be adapted to encompass future treatment developments. |
