Title: A Comparative Study of Lateral Sphincterotomy and Local Application of 2% Dilitiazem Gel in Treatment of Chronic Anal Fissure
Authors: K.K. Sinha, Mukesh Kumar, Rajeev Ranjan
DOI: https://dx.doi.org/10.18535/jmscr/v5i4.118
Abstract
Background: Anal fissures are commonly encountered in routine colorectal practice. Chronic fissures have traditionally been treated surgically. Developments in the pharmacological understanding of the internal anal sphincter have resulted in more conservative approaches towards treatment. In this study, we compare topical 2% Diltiazem gel and lateral internal sphincterotomy with respect to symptomatic relief, healing and side effects in the treatment of chronic fissure in ano.
Methods: 80 patients with chronic fissure in ano were randomly divided into Dilitiazem gel and internal sphincterotomy groups. Patients were followed up at weekly intervals for minimum of eight weeks. Data was recorded accordingly.
Results: Fissure completely healed in 37 (92.5%) out of 40 patients treated with 2% Diltiazem gel between 4-8 weeks. Healing was 100% with internal sphincterotomy. The mean duration required for healing of fissure was 4.86 weeks in Diltiazem gel group and 3.66 weeks in internal sphincterotomy group. 61.1% patients were free from pain after treatment with Diltiazem gel whereas in internal sphicterotomy group 67.5% patients had pain relief at the end of 4 weeks.
Conclusions: Comparison between Diltiazem gel application and internal sphincterotomy did not show any significant difference in fissure healing and pain relief. No side effects were seen in Diltiazem gel therapy. Topical Diltiazem should be the initial treatment in chronic fissure in ano. It is better to reserve internal sphincterotomy for patients with relapse or therapeutic failure to prior pharmacological treatment.
Keywords: Anal fissure, Diltiazem gel, internal sphincterotomy.
