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Comparative study of 2% Diltiazem ointment versus lateral internal sphincterotomy in the treatment of chronic anal fissure

Anand Rai Bansal, Robert Mark Wallang, Suvendu Sekhar Jena.

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Objective: Comparative study of 2% Diltiazem ointment versus lateral internal sphincterotomy in the treatment of chronic anal fissure. Study Design: The present study included a total of 50 patients presenting with chronic anal fissure. First 25 patients were subjected to 2% Diltiazem ointment(Group A) and the next 25 patients underwent open lateral internal sphincterotomy(Group B). Patients were followed twice a week initially and then at the end of 3rd and 6th week. At each visit they were examined for symptomatic relief of pain (VAS), healing of fissure, side effect or complications. The healed fissures were then subsequently followed up at 3 month for recurrence. Results: Complete relief of pain and fissure healing was observed in 72% and 96% patients in Group A and B respectively which is statistically significant for pain relief but not for fissure healing(p>0.001).There were no side effects such as pruritus ani in Group A or incontinence in Group B. Only 5.5% of patients in Group A and 8.33% in Group B had recurrence at the end of 3 month. However, there was no statistically significant difference in the frequency of recurrence between the two groups (P=0.561).Conclusion: Lateral Internal Sphincterotomy may be regarded as treatment of choice in the management of chronic anal fissure where as 2% Diltiazem can be used in elderly patients and those who refused surgery.

Key words: Anal fissure, Diltiazem, Lateral internal sphincterotomy

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