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Background: Chronic anal fissure is a common painful benign anorectal case. Surgical operations like lateral internal sphincterotomy or manual anal dilatation are effective forhealing most cases within a few weeks. However, as a side effect, permanent impaired anal.continence is likely to occurAim: This article aims to evaluate whether the pharmacological can be the first-line option for.the treatment of chronic anal fissure Patients and Methods: 60 patients are enrolled with a chronic anal fissure in this work. The cases were chosen randomly from Kirkuk general hospital during the period from February 2017 to October 2018. As a first-line therapy, all patients treated with diltiazem 2% cream for.6 weeks Results: As a result of adverse drug reaction and uncooperative patients, 10 patients were unable to complete medical treatment, while 50 patients were able to complete it. Furthermore, 40 patients (out of 50) achieved complete recovery with 25 males and 15females. Nevertheless, 10 patients (7 males and 3 females) were failed to reach complete recovery, which makes undergoing sphincterotomy as a second-line option. Completerecovery is achieved in (n=45) 90% of patients within 5-6 weeks from the start of diltiazem 2% cream. Whereas, 10% of them (n=5) recovered with complete 6 weeks administration of .the cream Conclusions: For majority patients with a chronic anal fissure, diltiazem 2% cream with a course of six weeks was the first-line choice therapy

Efficacy of Diltiazem 2% Cream as a Solid Treatment of Patients with Chronic Anal Fissure at Kirkuk General Hospital