# A Comparative Study of Topical 2% Diltiazem Versus Lateral Internal Sphincterotomy in the Treatment of Fissure-in-Ano

## TL;DR

This study compares a gel treatment and surgery for chronic anal fissures, finding both effective but with different side effects.

## Contribution

The study provides a direct comparison of healing rates and side effects between topical Diltiazem and lateral internal sphincterotomy for chronic anal fissures.

## Key findings

- Diltiazem gel achieved 82% healing rate, with most patients reporting low pain levels.
- Lateral internal sphincterotomy had a 68% healing rate but higher flatus incontinence and recurrence.
- Diltiazem is a viable non-surgical alternative for patients avoiding surgery.

## Abstract

Introduction: Chronic anal fissure is a common clinical entity seen in surgical practice. Lateral internal sphincterotomy is considered the gold standard for treating chronic fissures. But recent developments in understanding the pathophysiology of anal fissures have helped to develop better conservative treatment options. In this study, we compare the healing, symptomatic relief, and side effects of topical 2% Diltiazem gel versus lateral internal sphincterotomy in the treatment of chronic anal fissures.

Material and methods: In this prospective, randomised comparative study, 100 patients with chronic anal fissure were randomly divided into group A (Diltiazem gel) and group B (lateral internal sphincterotomy). Each group has 50 patients. Patients were followed up at the first, second, and third weeks and first, second, and third months, and symptomatic relief, healing, and side effects were noted for each group.

Results: More than 90% of the subjects in group A had a pain scale ≤ 3. Among group B, two subjects (4%) had pain rated as 4 after two weeks of treatment. The rate of healing in patients belonging to groups A and B is 82% and 68%, respectively, at the end of three months. In group A, one patient and, in group B, 15 patients showed flatus incontinence at six months. In group A, six (12%) patients and, in group B, one (2%) patient had recurrence.

Conclusion: Study concludes that lateral internal sphincterotomy remains the gold standard treatment for chronic anal fissure. Diltiazem therapy is a good alternative for patients who refused surgery or prefer medical line of treatment and can be used as a first choice in management of chronic fissures.