A COMPARATIVE EVALUATION OF TOPICAL 2% DILTIAZEM AND LATERAL INTERNAL SPHINCTEROTOMY IN THE MANAGEMENT OF CHRONIC ANAL FISSURE: A PROSPECTIVE CLINICAL STUDY

Background: Chronic anal ssure is a painful and debilitating condition of the anal canal, commonly presenting with severe pain during defecation, rectal bleeding, and discomfort that signicantly impairs quality of life. It is primarily caused by hypertonia and spasm of the internal anal sphincter, which hinders healing. Management strategies aim to relieve sphincter spasm and promote mucosal recovery. Both conservative medical therapies and surgical options like lateral internal sphincterotomy are employed based on severity and patient response. Methods: A prospective clinical study was conducted over 23 months (Nov 2019 – Sep 2021) including 60 patients with chronic anal ssure. Patients were randomized into two groups: Group A received 2% Diltiazem topical gel (n=30), and Group B underwent LIS (n=30). Primary outcome was ssure healing; secondary outcomes included pain relief, bleeding, anal incontinence, and recurrence. Results: Fissure healing was higher in Group B (96.7%) than in Group A (73.3%) (p=0.026). Pain relief was signicantly better in Group B (nal VAS 0.56 vs 2.26, p=0.001). Anal incontinence occurred in 33.3% of Group B (1 permanent), while Group A had only temporary incontinence in 3.3%. Recurrence occurred in 20% of Group A and 0% of Group B (p=0.024). Conclusion: LIS provides faster and more complete healing with better pain and bleeding relief but carries a higher risk of temporary incontinence. 2% Diltiazem is a safe, non-invasive alternative, suitable as rst-line therapy in compliant patients.