Abstract: Background and Aim: Anal fissures are
frequently seen in everyday clinical practice. In the past, surgical
intervention was the typical approach for treating anal fissures. Advancements
in the field of pharmacology have led to a shift towards more cautious
treatment methods for the internal anal sphincter. In this study, we compared
the effectiveness of applying 2% diltiazem gel and undergoing internal
sphincterotomy in treating chronic fissure-in-ano. We examined how well each
method promoted fissure healing and provided pain relief.
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.
