L. Ansaloni () Department of Emergency Surgery S. Orsola-Malpighi Hospital Via Massarenti 9 I-40138 Bologna, Italy e-mail: so10790@iperbole.bologna.it A. Bernabè • R. Ghetti • G. Gardini Department of General Surgery Lugo Hospital Ravenna, Italy R. Riccardi • R.M. Tranchino Department of General Surgery Faenza Hospital Ravenna, Italy the treatment period. Three fissures (14.3%) healed by 14 days and a total of 19 (90.4%) after 28 days: among the healed AF no recurrences were seen at the 2-month control. Among the two treatment failures, one was the patient who withdrew from the study at the 14-day control due to dyplop- ia and the other was a patient who failed to heal up to the 2- month follow-up, although completely asymptomatic. Both patients underwent left lateral sphincterotomy and healed. In conclusion, oral lacedipine is quite well tolerated and may offer a promising alternative treatment for AF. Key words Fissure in ano • Calcium channel blockers Introduction Anal fissures (AF) are thought to arise as a consequence of hypertonia of the internal anal sphincter (IAS), which impedes blood flow to the anal mucosa [1]. It is well demon- strated that in about 70%–80% of cases, AF are localised to the posterior anal commissure [2, 3] where the anoderm is less well perfused than other segments of the anal canal [4, 5] and its perfusion is strongly related to the anal pressure [6]. AF are therefore considered to be ischaemic ulcers of the anal canal, due to the increased activity of the IAS; therefore the reduction of IAS tone is the most important step in the treatment of AF [7, 8]. As calcium ions play an important role in muscle con- traction, calcium channel blockers, such as nifedipine and diltiazem, that inhibit smooth muscle excitation produced an abolition of resting tone in IAS smooth muscle in vitro [9, 10] and reduced resting anal pressure. Thus calcium channel blockers can heal AF, although with a high rate of side effects [11–15]. The aim of this study was to assess the effectiveness of lacidipine, a calcium channel blocker with a better tolera- bility in comparison to nifedipine and other calcium antago- nists [16, 17], in healing AF. Tech Coloproctol (2002) 6:79–82 © Springer-Verlag 2002 L. Ansaloni • A. Bernabè • R. Ghetti • R. Riccardi • R.M. Tranchino • G. Gardini Oral lacidipine in the treatment of anal fissure Received: 8 January 2002 / Accepted: 20 May 2002 ORIGINAL ARTICLE Abstract The aim of this prospective study was to assess the effectiveness in healing anal fissure (AF) of lacidipine, a calcium channel blocker with a better tolerability in com- parison to other calcium antagonists. Twenty-one consecu- tive patients (16 women, 76.2%) with AF (16 chronic, situ- ated posteriorly in 17 patients (81.0%), anteriorly in 4) with a mean age of 37.1 years (SD, 13.6, range, 20–65) were treated with oral lacidipine (6 mg daily) and warm sitz baths for 28 days, adding only stool softeners for patients with constipation. Blood pressure, pain scores (assessed from 0 to 10 on a visual analogue scale) and fissure healing were monitored at 14 days, 28 days and 2 months. At the 14-day and 28-day follow-ups, the mean systolic and diastolic pres- sures were not significantly different from pre-treatment levels. Seven patients (33.3%) developed side effects, but only one, who developed dyplopia, withdrew from the study at the 14-day control (non-compliance rate with treatment, 4.8%). Pain scores were significantly reduced after 14 days and continued to show a significant reduction throughout