Majid Aziz, Faran Kiani, Shahzad Ahmed Qasmi.
Comparison between lateral internal anal sphincterotomy and diltiazem in the treatment of chronic anal fissure.
J Surg Pak Jan ;17(1):16-9.

Objective To compare lateral internal anal sphincterotomy with 2% diltiazem in the treatment of chronic anal fissure in terms of fissure healing and complications. Study design Randomised controlled trial. Place & Duration of study Surgical unit Combined Military Hospital Lahore, from August 2008 to February 2009. Methodology Sixty patients were randomly assigned into two treatment groups. Group A was assigned to apply 2% diltiazem paste while, in group B lateral internal sphincterotomy (LIS) was done. Response to the treatment was assessed in terms of fissure healing, pain relief and occurrence of complications. Follow up of the patients was carried out at the end of 2nd , 4th , and 6th week of treatment. Results In group A six patients had healing of fissure after 4 weeks and a further 4th at 6th week. In group B 14 patients had healing at 2 weeks, 10 at 4 weeks, and 5 at 6 weeks. One patient in group B and 20 in group A had no healing. In this study overall healing rate after 6 weeks with diltiazem was 33.33% and 96.66% with LIS. Conclusion Lateral internal sphincterotomy is better than 2% diltiazem cream.

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