and Objectives: Anal fissures are commonly encountered in routine general surgical practice. Developments in understanding of anatomy,physiology and itsresponse to GNT/Diltiazemhas resulted in new conservative approach.In this study we compare the two modalities of treatment in chronic fissure in ano. Methods: In the study 80 patients of chronic fissure in ano was treated conservatively with0. 2% GTN/2% Diltiazem and lateral sphincterotomy based on the patient preference.The patients were

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... ed up for 5 to 6 weeks for symptomatic relief and healing of fissure and the results compared. Results: 1. The fissure healed completely in 46 patients with Diltiazem 2%/NTG0.2% application twice daily with Sitz bath.2. In 25 patients treated with surgery (Internal Lateral Anal Sphincterotomy), the fissure healed completely.3. The mean duration required for healing of fissure was 5.37weeks in Diltiazem/NTG group and 4 weeks in Internal sphincterotomy group.4.There were no side effects after Diltiazem/NTG therapy, 8 patients treated with sphincterotomy had pain in immediate post-op periods subsided with analgegics. Conclusion: Comparision between Diltiazem/NTG gel and Internal sphincterotomy did not show any difference in pain relief and fissure healing. But the time taken for healing was less in surgical group compared to conservatively managed group. Conservative treatment is equally efficacious as surgical treatment in this study.