A comparative study of chemical sphincterotomy (using 2% diltiazem) and lateral internal sphincterotomy for chronic anal fissure

Background: Anal fissure is the most common painful condition of anal region characterised by vertical ulcers affecting distal end of anal canal. The main aim of this study is comparing 2 % diltiazem and lateral internal sphincterotomy in the treatment of chronic anal fissure.Materials and Methods: The Study was conducted as a clinical trial in Sree Mookambika institute of medical sciences, Kulasekharam from May 2020 to November 2020.100 patients diagnosed with chronic fissure in ano on the basis of history of painful defecation with or without per rectal bleeding for more than 6 weeks and per rectal examination were enrolled in the study after obtaining an informed written consent from them. Results has been detailed in both descripted and statistical point of view and simplified in understandable format.Results: In 89.36% of patients in diltiazem group and 100% of patients in lateral internal sphincterotomy group fissure healed completely between 4-8 weeks. In the diltiazem group pain relief was good. 42 patients (89.4%) had pain relief at the end of 14 weeks. 5 patients (10.6%) had no pain relief. But pain relief in lateral internal sphincterotomy group was excellent with 100% patients having complete pain relief by 8 weeks’ time. Mild headache was experienced with diltiazem by 3(6.4%) patients.1 patient (2.1%) complained of flatus incontinence with lateral internal sphincterotomy.Conclusion: We conclude that lateral internal sphincterotomy is the gold standard treatment of chronic fissure in ano but chemical sphincterotomy using 2% diltiazem gel can be considered as a good second line treatment option in those unfit for surgery or for those not willing for surgery.