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Background: The more painful cause of excruciating anal pain is anal fissures. An anal fissure, known as a f issure-in-ano, is a vertical split that runs from the anal margin proximally to the dentate line but does not go past it Aim: Compare the fissure healing process and side effects of a smooth muscle relaxant, topical treatment 2% diltiazem gel, with lateral internal anal sphincterotomy (LIS) in the treatment of chronic anal fissures Materials and Methods: Random controlled trial was dine in Surgical unit Samarra General Hospital, from October 2018 to August 2019 with 6 months follow-up. The study included 60 cases chronic anal fissure surgery outpatients and/or hospitalized patients were randomly grouped into one of two groups: Group A (topical Diltiazem gel) or Group B (lateral internal sphincterotomy operation), with 30 patients in each. Results: Patients were checked on every week for a six weeks in a row, after that every two weeks for the next three weeks were healed, followed by ten at 4 weeks and five at 6 weeks. 20 patients with group A and 1 patient with group B did not heal. The overall healing rate in this trial was 32% with diltiazem and 98 % with lateral internal anal sphincterotomy operation after 6 weeks (LIS) Conclusion: It has been determined that lateral internal sphincterotomy is superior to 2% diltiazem gel
