Anal fissures are common causes of morbidity in the surgical units. The severe pain during and after defecation greatly

impacts on the quality of life of many patients. Acute anal fissures responds poorly to medical treatment and are therefore best managed using surgical methods. Lateral internal sphincterotomy is the gold standard in the treatment of anal fissures.

Aim: To compare the efficacy of chemical and surgical lateral internal sphincterotomy in patients of acute anal fissure.

Methods: A Randomized controlled trial conducted at Department of Surgery, Unit-II, Fatima Memorial Hospital, Lahore. The duration of the Study was over a period of six months from 10-09-2018 to 09-03-2019.A total of 100 patients (50 in each group) were included in the study. Group-A was treated with chemical sphincterotomy local application of glyceryl trinitrate 0.2 percent ointment and Group-B was treated with surgical lateral internal sphincterotomy.

Results: Patients were ranged between 15-60 years of age. Mean age of the patients was 36.64±10.05 and 33.42±11.47 in group-A and B, respectively. In group-A 13 patients (26%) and in group-B 15 patients (30%) were male and 37 patients (74%) in group A and 35 patients (70%) were female. Efficacy was observed in 16 patients (32.0%) of group-A and 50 patients (100%) of group B. There was a statistically significant difference between two groups (p<0.001).

Conclusion: In conclusion, surgical sphincterotomy was significantly more effective in providing postoperative pain relief (p<0.001). However, chemical sphincterotomy is a non-invasive, cost-effective, easier to apply, well-tolerated and effective therapy for anal fissure and is a first line treatment especially in patients who are unwilling or unfit for surgery.

Key words: Chemical sphincterotomy,  lateral internal sphincterotomy, Acute anal fissure