4 Nifedipine Gel with Lidocaine in the Treatment of Anal Fissure in Children: A Pilot Study and Review of the Literature Baruch Klin 1 , Ibrahim Abu-Kishk 2 , Yigal Efrati 1 and Gad Lotan 1 1 Department of Pediatric Surgery & 2 Pediatric Intensive Care Unit, Assaf Harofeh Medical Center, Zerifin, Affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel 1. Introduction Anal fissures are common in infancy and represent the most common cause of bright rectal bleeding at any age. Delayed diagnosis and treatment can lead to a disturbing cycle of constipation, repeat rectal bleeding, and crying, due to increasing pain during and after defecation. In spite of its high frequency, the problem remains underrated by most clinicians, with only a paucity of data on the management of anal fissures in children being found in the literature. The objective of this work is to bring this common and distressing problem into a more positive light, based on our good results achieved by the nifedipine gel with lidocaine treatment. 2. History The first description of anal sphincterotomy in the world literature is found in Alexis Boyer's 11-volume Traite des Maladies Chirurgicales published between 1818 and 1826 (DeMoulin, 1977). His descriptions of the condition are dramatic, detailing the severe suffering patients endured. Louis Lemmonier, in 1869, gave the world the first anatomic description of an anal fissure. Boyer established the relationship between anal sphincter spasm and no healing of anal fissures, as well as the association between constipation and anal fissure. He was the first to divide the sphincter to cure the problem. This procedure, routine and quite safe today, caused deaths and pelvic abscesses in four patients, as reported by Velpeau in 1832. During the 1950s, fissure excision, anal sphincter stretching, injection therapy (local anesthetic and sclerotherapy) and sphincterotomy were performed for chronic anal fissures. Later, in the late 1960s and early 1970s, cutaneous island advancement flaps were added to this group (Ruiz-Moreno, 1968; Samson & Stewart, 1970). The modern reintroduction of sphincterotomy for anal fissure can be attributed to Eisenhammer (1951). In 1953, Inburg published his technique of partial internal sphincterotomy, cutting the sphincter through the bed of the fissure. It was not until the mid to late 1970s that lateral internal sphincterotomy became accepted as the standard of care to treat anal fissures surgically (J. Nelson, 2006). www.intechopen.com