[Year:2020] [Month:September-December] [Volume:5] [Number:3] [Pages:6] [Pages No:77 - 82]
Introduction: A chronic anal fissure is a common anorectal condition associated with high sphincter pressure and a reduction in mucosal blood flow, with secondary local ischemia and a poor healing tendency. The principle of treatment is breaking the cycle of pain, spasm, and ischemia thought to be responsible for the development of fissure in ano. Aim: To assess and compare the topical application of 0.3% nifedipine and lateral internal sphincterotomy as treatment modalities in patients diagnosed with chronic anal fissure. Materials and methods: This study was a prospective comparative study where 100 patients who presented in a surgical outpatient department of MGMCH, Jaipur with complaints of the painful passage of stool, with or without bleeding of >6 weeks duration, diagnosed to be having chronic anal fissure, were randomly selected and classified into two groups, each consisting of 50 patients. The patients in the first group were subjected to pharmacological sphincterotomy using topical application of 0.3% nifedipine while patients in group II were subjected to lateral sphincterotomy. Outcomes in each group were followed up at 2, 4, 6, 8, and 12 weeks. Results: In our study, fissures at 4, 6, 8, and 12 weeks were healed in 78, 86, 92, and 90% patients, respectively, in the nifedipine ointment group whereas in the lateral sphincterotomy group fissures at 4, 6, 8 and 12 weeks had healed in 88, 92, 98, and 98% patients, respectively. Nineteen patients (38%) developed side effects in the nifedipine group, compared with 10 patients (20%) in the sphincterotomy group. Conclusion: With good treatment outcome nifedipine ointment has the potential to become the first-line treatment for chronic anal fissures. It represents a new, promising, effective alternative to lateral internal sphincterotomy but in case pharmacological therapy fails, lateral sphincterotomy is the surgical option of choice.