A Prospective Comparative Observational study in treatment of anal fissure – Topical Diltiazem vs Topical Nitroglycerin

Gagandeep, Vivek Pahuja, Rohit Goyal, Pankaj Dugg
Author(s)
1Assistant Professor, Department of Surgery, Dr B R Ambedkar State Institute of Medical Sciences, SAS Nagar, Punjab, India. 2Associate Professor, Department of Surgery, Dr B R Ambedkar State Institute of Medical Sciences, SAS Nagar, Punjab, India. 3Senior Resident, Department of Surgery, Dr B R Ambedkar State Institute of Medical Sciences, SAS Nagar, Punjab, India. 4Assistant Professor, Department of Surgery, Government Medical College, Amritsar, Punjab, India

Abstract

Background: Anal fissure is a common condition in surgical practice. The treatment is usually conservative. Topical calcium channel blockers are used to decrease the tone of anal sphincter. Material and Methods: The prospective observational study was carried out on 60 cases on out-patient basis. The study population was divided into two groups of 30 patients each. Group was treated with topical application of 2% diltiazem per rectally twice daily. Group B was treated with topical application of 0.2% nitroglycerin/ Glyceryl trinitrate twicw daily. The treatment was given for a period of 6 weeks along with sitz bath and oral antibiotics. The two groups were compared for degree of symptom relief, healing, any adverse drug effect and recurrence if any. Statistical analysis was done on SPSS software version 21. P value of <.05 was considered significant. Results: On completion of therapy at 6 weeks healing was observed in 26(86.6%) patients in group A and in 21(70%) patients in group B, so there was no statistically significant difference between two groups. At 2 weeks and 6 weeks follow up headache was significantly higher in group B as compared to group A (p<.05). Conclusion: Chemical sphincterotomy with topical 2 % Diltiazem gel is an effective first-line treatment for anal fissures, achieving symptom relieving and healing rates comparable to those achieved with 0.2 % Nitroglycerin ointment but with relatively few, generally acceptable side effects as compared to distressing adverse effects of nitroglycerin as headache.

Keywords: Anal fissure, Calcium Channel Blockers, Nitroglycerin, Constipation.

Outline