Comparative Study of Chemical Sphincterotomy and Lateral Internal Sphincterotomy for Chronic Anal Fissure Kumar Nitesh1,*, Pankaj Deepak1, Nitesh2, Kumar Ashwini2, Raj Monika3 1Assistant Professor, Department of General Surgery, IGIMS, Patna 2Senior Resident, Department of General Surgery, IGIMS, Patna 3Intern, Department of General Surgery, IGIMS, Patna *Corresponding author: Dr. Nitesh Kumar, Assistant Professor, Department of General Surgery, IGIMS, Patna, Mobile no. 9971060788, Email id- todrnitesh@gmail.com
Online published on 17 July, 2019. Abstract Introduction Fissure-in-ano is a very common problem which causes considerable morbidity and affects the patient's quality of life to a great extent. This warrants prompt treatment of the condition with appropriate methods. In this study, we assess and compare the efficacy and adverse effects of topical application of 2% Diltiazem gel with that of Lateral internal sphincterotomy. Method 100 patients with chronic fissure in ano were divided into Diltiazem gel and Lateral internal sphincterotomy groups and followed up at regular intervals for symptomatic relief and healing. Results Fissure was completely healed in 42 (89.36%) out of 47 patients by 8 weeks in the Diltiazem group, 3 patients experienced mild headache, 2 local irritation, 13 patients were pain-free at the end of 4 weeks, 26 patients were 8 weeks and 3 patients by 14 weeks. 5 patients were not relieved of pain at the end of 14 weeks. Completely healed in 48 (100%) out of 48 patients by 4 weeks in the Lateral Internal Sphincterotomy group.21 patients experienced post-operative pain and incontinence for flatus in 1 patient. 32 patients were pain-free by 4 weeks and all the patients were free of pain by 8 weeks. Conclusion The current study shows results in favour of lateral internal sphincterotomy with a healing rate of 100% with a faster pain-relief and minimal complications if performed by the experienced surgeon. However topical 2% diltiazem gel is an effective agent can be safely prescribed for patients having contraindications for surgery. With a healing rate close to 90%, topical 2% Diltiazem therapy can be advised as the first line of treatment for the treatment of chronic anal fissure. Top Keywords Anal Fissure, Diltiazem, Internal Sphincterotomy. Top |