A Prospective, Randomised Comparative Study of Lateral Sphincterotomy and Local Application of 2% Diltiazem Gel in Treatment of Chronic Anal Fissure.

ABSTRACT

Background: Surgical management is used for the treatment of most of the fissures including manual anal dilation or performing lateral sphincterotomy. The present study carries a comparative research between the patients posted for lateral internal sphincterotomy and application of 2% Diltiazem gel in chronic anal fissure. Methods: The study was conducted in Department of General Surgery, Teerthankar Mahaveer Medical College & Research Centre from May 2015 to April 2016. After informed written consent, 60 patients were enrolled in the study. All patients were allocated in two groups; Group S (30 patients) posted for Lateral Sphincterotomy and Group D (30 patients) consisting of 2 % Diltiazem gel therapy. Results: Out of 30 patients, 3 lost during the follow up period in Group D. 19 patients (63.33%) had complete healing at the fissure site upon application of Diltiazem (2%) gel at 4 week follow up. In case of Group S, 26 patients (86.67%) had complete healing of fissure at 4 weeks follow up while 2 patients had complete healing at 8 week follow up visit. 22 (73.33%) of the patients treated with diltiazem (2%) gel were pain free at the end of 4 weeks. 27 (90.00%) out of 30 patients undergoing lateral internal sphincterotomy were free from pain at the end of 4 weeks post operatively. Conclusion: Lateral internal Sphincterotomy is the first line of treatment in patients for the chronic fissure in ano.