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COMPARATIVE STUDY BETWEEN SURGICAL TREATMENT AND DILTIAZEM 2% GEL APPLICATION IN THE MANAGEMENT OF CHRONIC ANAL FISSURE
*Ammar Khiatah, Ahmad Saad and Sajieh Massoud
Introduction: The surgical intervention on chronic anal fissure is still the first line of treatment for this disease. The importance of this research lies in finding a new treatment for one of the most common anal lesions, and to choose a safe and effective method in the treatment of chronic anal fissure, avoiding the risks of anesthesia and surgery. Objective: To compare the surgical treatment (Lateral Internal Sphincterotomy) and topical treatment (Diltiazem Gel 2%), in terms of the ability to heal, studying the degree of symptoms regression after the treatment (bleeding/pain), and studying the incidence of gas / fecal incontinence. Materials and Methods: A prospective pilot study, which included 60 patients divided into two groups equally, Group A (30 patients who underwent surgical treatment), Group B (30 patients who underwent topical drug treatment with Diltiazem 2% gel), and the study was conducted at Tishreen University Hospital in Latakia – Syria, in the period between 2019-2020. Results: In group A, complete recovery occurred in 29 patients (96.6%), anal bleeding decreased in all patients (100%), pain feeling decreased in all patients (100%), and gas incontinence occurred only in 4 patients (13.3%). Fecal incontinence didn't occur. In group B, complete recovery occurred in 17 patients (56.6%), anal bleeding decreased in 17 patients (68%), pain feeling decreased in 17 patients (65.3%), and gas / fecal incontinence didn't occur at all. Conclusion: Lateral internal Sphincterotomy is still the first line of treatment in patients with a chronic anal fissure, but drug therapy with (Diltiazem 2% gel) can be applied to patients who refuse surgical treatment, or for those who have contraindications for surgical intervention.[Full Text Article]