CONSERVATIVE LATERAL INTERNAL ANAL SPHINCTEROTOMY VERSUS TOPICAL DILTIAZEM IN THE MANAGEMENT OF CHRONIC ANAL FISSURE

Abstract

Objectives: To compare and assess the efficacy of conservative lateral internal sphincterotomy with topical diltiazem in the management of chronic anal fissure.
Study design: Quasi experimental.
Place and Duration of Study: Surgical Unit IV, Liaquat University of medical and health sciences, Jamshoro from 1st March 07 to 31st August 08.
Patients and methods: In total, 70 patients were included in the study and were divided into two groups. Group A was prescribed topical diltiazem whereas group B underwent conservative lateral anal sphincterotomy. Patients were followed up at 2nd, 4th and 8th week. The markers of efficacy were pain relief, healing of fissure, incontinence and recurrence. Data was collected on a questionnaire and was analyzed statistically using SPSS version 10. The p values were calculated using chi-square test and were considered significant below 0.05.
Results: Conservative lateral internal anal sphincterotomy produced a statistically significant response in comparison with topical diltiazem in terms of pain relief at first follow up (p=<0.001). It was also associated with a better response rate of healing of fissure at the end of study and recurrence rates (p=0.002, 0.019). However, at the end, topical diltiazem was associated with symptomatic relief in study population that was statistically insignificant (p=0.033). Also patients who underwent conservative lateral internal sphincterotomy, 3 of them developed transient incontinence. None of the patients in diltiazem group experienced fecal incontinence.
Conclusion: Conservative lateral internal anal sphincterotomy remains the modality of choice in the management of chronic anal fissure as it provides early pain relief, better healing rates and minimum number of recurrence. However, topical diltiazem can be prescribed as first line of management since it is non-invasive and is free of complications associated with surgical division of internal anal sphincter.