Vol. 3, Issue 1, Part D (2019)

Material and Methods: One hundred patients with chronic fissure in ano were identified and included in this prospective comparative study conducted over a period of one year at a tertiary care institute in India. There were two groups of patients, with 50 in each group, labeled as group A and group B. Patients in group A were instructed to use 2% diltiazem gel twice a day for duration of 6 weeks. Patients in group B received left lateral internal sphincterotomy while under spinal anesthesia. The healing of fissures and the relief of pain were documented upon presentation and throughout subsequent visits.

Results: The findings indicate that a significant majority of the cases were observed in individuals aged 21-30 years, with a higher prevalence among females (55%) compared to males (45%).At the end of 3 months, a significant number of patients in both group A, who used diltiazem gel, and group B, who used LIS, experienced complete healing of their fissures. Specifically, 78% of patients in group A and 84% of patients in group B achieved this positive outcome. At the end of 3 months, a significant number of patients in both group A, who used Diltiazem gel, and group B, who received LIS, experienced pain relief. Specifically, 82% of patients in group A and 90% of patients in group B were free from pain.

Conclusion: It is recommended that chemical sphincterotomy with topical 2% diltiazem gel application be considered as the primary treatment option for chronic anal fissure. It can also be beneficial for individuals who are not suitable candidates for surgery. Patients who have experienced relapse and therapeutic failure of previous pharmacological treatment should be considered for LIS.