Role of Chemical versus Surgical Sphincterotomy in Treatment of Fissure in Ano

Background: Fissure in ano affects morbidity and quality of life of patients. Lateral internal sphincterotomy is the standard treatment for this condition. Chemical sphincterotomy using 2 percent Diltiazem gel is reported to be effective. This study was conducted to compare the efficacy of 2% diltiazem gel in the treatment of chronic fissure in ano with lateral internal sphincterotomy.

Methods: 60 patients with fissure in ano were randomly divided into two groups of 30 each. Group A received 2% diltiazem gel applied topically and group B was treated with lateral internal sphincterotomy. The treatment outcomes were compared based on time to pain relief and time to complete healing of fissure.

Results: Patients in both groups were comparable in terms of age, sex, dietary habits, and duration of symptoms. All patients complained of pain;however, majority had no relation of pain with defecation. 90% patients of group A and 96.7% patients of group B had constipation. Only 20% patients of group A and 36.7% of group B had bleeding per rectum. Sentinel tag was present in 46.7% patients in group A and 66.7% patients in group B. Pain was relieved earlier with LIS as compared to medical treatment with diltiazem. At 4th week 80% patients undergoing LIS but only 26.6% patients in diltiazem group had complete pain relief. However, all patients in both groups were relieved of pain by 12th week of treatment. With surgical treatment 19 (63.3%) patients had completely healed fissures at 4 weeks, as compared to none in group A. Although all fissures healed in both the groups at 12 weeks, healing of fissures occurred late in diltiazem group.

Conclusion: All patients in both groups had pain relief and complete healing of fissures by 12th week, though response was delayed in patients receiving conservative treatment.