A Comparative study of 2 percent diltiazem versus lateral sphincterotomy in the management of anal fissure

  • Apoorv Chauhan, Anurag Chauhan, Brijesh Kirar, Nishant Guptageneral surgery


Introduction: Anal fissures are longitudinal tears in the squamous epithelium of the anal canal. Anal fissures are located distal to the dentate line,
and in around 90% of cases they are located on the posterior midline. The most common pathologies of the anorectal region and can change the
quality of life as it causes patient pain and emotional stress while defecation. With a lifetime risk of 11%, anal fissure is a common problem in
routine medical care. Anal fissure is mainly treated by relaxing the spasm of the internal sphincter either by dilating the anal canal or
sphincterotomy. Reduction of spasticity of anal sphincters is the special treatment for fissure healing. For this purpose, the treatment of anal fissures
is performed by lateral sphincterotomy or by anal dilatation. Methods: Out of 100 randomly selected 50 patients with inclusion and exclusion
criteria and informed consent were treated with diltiazem ointment and 50 patients with informed consent were treated with lateral sphincterotomy
for management of anal fissure. Observations after treatment were recorded at second week, sixth week and twelfth week interval for  pain
and healing and at the twelfth week follow up was documented to analyse the result of treatment. Result: Out of 50 patients undergoing
treatment with diltiazem ointment 42 patients healed completely. . Patients in lateral sphincterotomy group underwent surgery under spinal anaesthesia. In lateral sphincterotomy group, fissure healing was found in 49(98%)out of 50 patients. In our study out of 50 patients, 48 (96%)were completely relieved from pain and 2 ( 4% ) had pain on follow up at theend of 3 months. . Conclusion: Topical 2% diltiazem should be
given as the first option of treatment for anal fissure. Lateral sphincterotomy, which gives better result to relieve the symptoms but require
hospitalization, should be offered to patient who present with relapse and does not respond to pharmacological treatment