Background: Anal fissure is common anorectal problem which causes painful defecation and bleeding. This adversely affects the quality of life and daily activities of the patients. This study was carried out to compare the efficacy between topical use of nifedipine and lateral internal sphincterectomy.

Methods: This was a prospective study conducted over 82 patients in two groups, comprises 41 patients in both group. Group I patients underwent conservative management with nifedipine, patients in group II underwent lateral internal sphincterectomy.

Results: Pain control was76% and 84% in patients with nifedipine treatment, whereas in sphincterectomy group 82% and 96% at 4 and 8 weeks respectively. Reduction in bleeding episode and sphincter relaxation was 96% and 98% in conservative versus surgical groups respectively at 8 weeks. Wound healing was also faster in lateral sphincterectomy 92% group compare to nifedipine group 73% at 8 weeks.