Comparison Between the Therapeutic Effects of Internal Sphincterotomy and Diltiazem Gel in Chronic Anal Fissure

Surgery is now the "treatment of choice" for chronic anal fissure. However, considering the pathogenesis of this disease and the tendency for noninvasive and economical procedures, more attention is growing towards the non surgical treatments. Oral or topical nitroglycerin, isosorbide, bethanechol, L-Arginine, nifedipine, diltiazem, adrenergic –antagonists and botulinum toxin have been used to treat chronic anal fissure. In this study, we compared the surgical sphincterotomy and topical diltiazem gel for the treatment of anal fissure. This clinical trial study was performed on two groups of 35 patients. The first group was treated by surgical sphincterotomy and the second group received the topical diltiazem gel. Both groups were examined 2,4 and 6 weeks after the onset of the treatment and, the findings were recorded and statistically analyzed by SPSS, t-test and X2 to determine the relation between parameters and p<0.05 was considered to be significant. Two weeks after the onset of treatment, the rate of complete pain relief in the sphincterotomy group and in the diltiazem group was 75% and 45% respectively (p<0.005). Although this value was the same in both groups 4 weeks after treatment (p=0.357), the wound healing process observed in the first group was significantly higher than the second group (85% VS 40%, p<0.0001). Both groups had a similar wound healing rate in the 6th week (p=0.0351). According to our findings, both the surgical sphinctorotomy and the topical diltiazem gel had a similar therapeutic effect on the chronic anal fissure. However, the topical diltiazem gel has shown to have several advantages such as lower complication rates, greater convenience, noninvassivess, (no hospitalization) and lower cost. Therefore this type of treatment considered to be more appropriate for chronic anal fissure, and the surgery should be used as an alternative option for special cases.