Year: 2026 | Month: June | Volume: 16 | Issue: 6 | Pages: 166-177
DOI: https://doi.org/10.52403/ijhsr.20260619
Comparison of the Efficacy of 2% Diltiazem gel versus Lateral Sphincterotomy in the Management of Fissure-in-Ano
Yogita Suri1, Huma Shamim2, Punit Kumar3, Anil Negi4, Sudesh Kumar Sagar5
1Junior Resident, 2Assistant Professor, 3,4,5Professor,
1,2,3,4,5Department of General Surgery
Shree Ram Murti Smarak Institute of Medical Sciences, Bareilly, U.P.
Atal Bihari Vajpayee University, Uttar Pradesh India.
Corresponding Author: Yogita Suri
ABSTRACT
Introduction: Fissure-in-ano is a common anorectal condition characterized by severe pain, bleeding, and impaired bowel performance. While lateral internal sphincterotomy remains the standard surgical treatment, topical calcium channel blockers such as 2% Diltiazem gel have emerged as a promising non-invasive alternative.
Objectives: To compare pain relief, fissure healing, and treatment-related complications between 2% Diltiazem gel and lateral internal sphincterotomy.
Methods: This prospective interventional study was conducted from April 2024 to September 2025 in the Department of General Surgery, SRMS IMS, Bareilly. Sixty-six patients fulfilling inclusion criteria were randomized into two groups: Group A received 2% Diltiazem gel, and Group B underwent lateral internal sphincterotomy. Outcomes were assessed weekly for four weeks using the Visual Analogue Scale (VAS), Victoria Bowel Performance Scale, DREss score, bleeding status, anal tone, and complications. Statistical analysis was performed using independent-samples t-test, Fisher's exact test, and repeated-measures ANOVA.
Results: Both groups were comparable in baseline demographic and clinical characteristics (p>0.05). Pain scores progressively improved in both groups during follow-up. However, at week 4, patients undergoing lateral internal sphincterotomy had significantly lower mean VAS pain scores compared with the diltiazem group (0.12 ± 0.33 vs. 0.74 ± 1.02; p=0.002). Bleeding resolved completely in all patients by week 4. Complete fissure healing was achieved in 87.9% of patients in the lateral internal sphincterotomy group compared with 60.6% in the 2% diltiazem group (p=0.010). No major complications were observed in either group.
Conclusion: Both topical 2% diltiazem gel and lateral internal sphincterotomy significantly improved symptoms and promoted fissure healing in patients with chronic fissure-in-ano. However, lateral internal sphincterotomy achieved significantly higher healing rates and lower week-4 pain scores. Despite its comparatively lower healing rate, topical 2% diltiazem remains a safe and effective first-line conservative treatment option for patients wishing to avoid surgical intervention.
Key words: Fissure-in-ano; Diltiazem gel; Lateral internal sphincterotomy; Pain relief; Anal tone; Anorectal disorders.