Comparative study of topical diltiazem with lateral internal sphincterotomy in management of chronic anal fissure

Introduction: Chronic anal fissure is persistent or recurrent painful linear ulcer situated in anal canal just below the dentate line to the anal verge and fails to heal within 6-8 weeks. For these fissures, partial lateral sphincterotomy is done which diminishes internal anal sphincter hypertonia and anal canal pressure but can lead to long term disturbances of sphincter function. In the present study we have compared medical management by topical diltiazem ointment with established surgical procedure of lateral internal sphincterotomy in the management of chronic anal fissure. Material and Methods: This was a prospective comparative randomised study, carried out on 100 patients of chronic anal fissure at S.M.S. Medical College, Jaipur. Intensity of pain was recorded on 0-10 Numeric Rating Scale and Wong-Baker Faces Pain Rating Scale (Visual analogue scale) on presentation and during follow up visits. Selected patients were put under two groups of 50 participants each, A (study group, diltiazem group) and B (control group, partial lateral sphincterotomy group) using simple randomization technique and were to receive treatment accordingly. Results: 26% patients of study group and 42% patients of control group reported no pain at 1st week of treatment. 72 % patients of study group and 94 % patients of control group reported no pain at 8th week of treatment. Conclusion: Topical diltiazem gel has shown to have several advantages and can be considered first line topical treatment but Partial lateral internal sphincterotomies still gold standard procedure for chronic anal fissure.