Diltiazem gel versus Lateral Sphincterotomy in the Treatment of Anal Fissures

Abstract

Background: An anal fissure is defined as an ulcer in the anoderm usually in the posterior midline, less frequently in the anterior midline, and rarely in the lateral position of the anal canal.  
Objective: The objective of this study was to compare the efficacy of outcome of lateral internal sphincterotomy with topical 2% Diltiazem gel in the treatment of chronic fissure in ano. 
Methodology: 100 patients were randomly selected from the admitted patients with chronic fissure in ano. where this study was done from August 2018 to August 2019.  were randomly divided into Group 1 (Diltiazem gel) and Group 2 (internal sphincterotomy) with 50 patients in each Group. The data obtained was analysed using SPSS software version 20.0. 
Results: Dominant part of the fissure were back in area with sentinel pile present in 46 of cases. Cases were followed up at week by week intervals for 6 sequential weeks and every other week for consequent 3 months. 2 cases  from  Group  1developed  fistula  in  ano  and  required  medical procedure. 25 of patients in Group 1 and 50 of patients in Group 2 had completely healed fissures at the end of 4 weeks. 48 of patients in Group 1 who were totally healed with Diltiazem gel application and 49 of patients in Group 2 were free from pain toward the part of the arrangement. Three patients in Group 1, whose fissure did not recuperate following a month and a half of Diltiazem application and stayed symptomatic, in this manner experienced inner sphincterotomy and fissures healed in about a month after medical procedure. The mean length of healing was relatively longer in  Group  1(5.04  weeks)  than  Group  2  (3.6  weeks).  Confusion  was accounted for in 1 case in Group1 which was return in signs and indications which required sebsequent medical procedure.
Conclusion: 
Hence Subcutaneous fissurectomy with topical 2% Diltiazem gel is a better surgical option for chronic fissure in ano than conventional Lateral internal sphincterotomy.