LATERAL INTERNAL SPHINCTEROTOMY VERSUS 2% DILTIAZEM GEL LOCAL APPLICATION : A COMPARATIVE STUDY IN TREATMENT OF CHRONIC FISSURE IN ANO

YOGESH KUMAR YASHASWI; PAWAN KUMAR JHA

Volume : VIII, Issue : V, May - 2018

LATERAL INTERNAL SPHINCTEROTOMY VERSUS 2% DILTIAZEM GEL LOCAL APPLICATION : A COMPARATIVE STUDY IN TREATMENT OF CHRONIC FISSURE IN ANO

Yogesh Kumar Yashaswi, Pawan Kumar Jha

Abstract :

Introduction: Anal fissures are commonly encountered in routine clinical practice. Anal fissure has 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 aim to compare symptomatic relief, healing and side effects of topical 2% Diltiazem Gel and Lateral internal sphincterotomy (LIS) in the treatment of chronic fissure in ano.

Material and Methods: In this prospective trial, 40 surgical out patients and/or admitted patients with chronic fissure in ano were randomly divided into Group 1 (Diltiazem Gel) and Group 2 (LateralInternal Sphincterotomy) with 20 patients in each Group.Patients were followed up at weekly intervals for 6 consecutive weeks and biweekly for subsequent 3 months.

Results: Fissure was completely healed in 90% of patients in Group 1 and 100% in Group 2. The mean duration required for healing of fissure was 5.04 weeks in Group 1 and 3.60 weeks in Group 2. 80% patients were free from pain in Group 1 whereas 85% patients were free from pain in Group 2. No patient had any side effects in either group.

Conclusion: Topical Diltiazem should be considered as first line of treatment in chronic fissure in ano. Lateral internal sphincterotomy should be reserved for patients with relapse and therapeutic failure to prior pharmacological treatment.