A Comparative Study of 0.3% Nifedipine and Lateral Anal Sphincterotomy in Anal Fissure

Background: Chronic anal fissure is a common anorectal condition characterized by severe pain, bleeding per rectum, and internal anal sphincter spasm. Lateral internal sphincterotomy remains the gold standard treatment; however, concerns regarding postoperative complications, especially incontinence, have led to increasing interest in non-surgical alternatives such as topical nifedipine.

Aim: To compare the efficacy of 0.3% nifedipine ointment with lateral internal sphincterotomy in the management of chronic anal fissure.

Methods: A prospective comparative study was conducted on 60 patients with chronic fissure in ano, divided equally into two groups. Group X received topical 0.3% nifedipine ointment twice daily for 6 weeks, while Group Y underwent lateral internal sphincterotomy. Patients were followed up for 10 weeks, and outcomes assessed included fissure healing rate, pain relief, bleeding per rectum, recovery time, recurrence, and incontinence.

Results: The healing rate was higher in the surgical group (96.7%) compared to the nifedipine group (83.3%). Pain relief and recovery time were also better with surgery. However, the nifedipine group showed negligible risk of incontinence, whereas temporary and minimal permanent incontinence was noted in the surgical group. Recurrence was higher with nifedipine (10%) compared to none in surgery.

Conclusion: While lateral internal sphincterotomy remains the most effective treatment for chronic anal fissure, topical 0.3% nifedipine offers a safe, non-invasive alternative with good efficacy and minimal complications, making it suitable as a first-line therapy.