A Quazi-Experimental Study to Compare Outcome between Lateral Sphincterotomy, Topical 2% Diltiazem and Topical 0.2% Nitro-Glycerine in the Management of Chronic Anal Fissure

Though fissures had traditionally been treated surgically, developments in the pharmacological understanding of the internal anal sphincter have resulted in more conservative approaches towards treatment. The objective was to compare the efficacy of topical 2 % Diltiazem gel, 0.2 % Nitroglycerine ointment and lateral internal sphincterotomy in the treatment of chronic fissure in ano.60 patients with chronic fissure in ano were divided into Diltiazem gel, Nitroglycerine ointment and internal sphincterotomy groups with each group containing 20 patients each. Fissure was completely healed in 16 (80 %) out of 20 patients treated with 2 % Diltiazem gel and 0.2 % Nitroglycerine ointment between 4-8 weeks. Healing was 100 % with internal sphincterotomy.95 % patients were free from pain after treatment with Diltiazem gel, 90 % patients were free from pain after treatment with Nitroglycerine ointment whereas 100 % patients were free from pain after treatment with lateral sphincterotomy. Topical Diltiazem can be established as the initial treatment in chronic fissure in ano. Lateral sphincterotomy should be reserved for patients with relapse and therapeutic failure to prior pharmacological treatment.