A parallel group , open label study

  • Sonam Yadav General Surgery Department, SBLS Civil Hospital, Jalandhar, Punjab, India
  • Satinderjit Singh Bajaj General Surgery Department, SBLS Civil Hospital, Jalandhar, Punjab, India
  • Jagminder Kaur Bajaj Punjab Institute of medical sciences
Keywords: lateral internal sphincterotomy, diltiazem gel


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 all 30 (100%) patients undergoing LIS but only 33% patients in diltiazem group had complete pain relief. however, all patients in diltiazem group were also relieved of pain by 9th 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 by 9th week and complete healing of fissures by 12th week though response was delayed in patients receiving conservative treatment.


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