Efficacy of chemical sphincterotomy with 2% diltiazem cream vs. surgical sphincterotomy in the management of chronic fissure in ano: a clinical study


  • Jeevan Kenche Department of General Surgery, Government Medical College, Mahabubnagar, Telangana, India
  • Chandrashekhar Reddy Department of General Surgery, Government Medical College, Mahabubnagar, Telangana, India




Chemical sphincterotomy, Chronic fissure in ano, Outcome, 2% topical diltiazem


Background: Surgical intervention like lateral internal sphincterotomy is very effective and in a time of few weeks, healing can occur but there is danger of the anal incontinence. Hence alternative methods were sought like 2% diltiazem and other agents and they have been shown to lead to proper healing without anal incontinence. The objective was to study efficacy of chemical sphincterotomy with 2% diltiazem cream vs. surgical sphincterotomy in the management of chronic fissure in ano.

Methods: A hospital based follow up study was carried out among 60 patients with chronic fissure in ano. They were randomly assigned in two groups. Group I consisted 30 patients who were treated with 2% diltiazem cream on outpatient basis. Group II patients i.e. 30 patients were operated for sphincterotomy. Both the group patients were followed for six weeks at two weeks interval. Outcome like complete healing, fecal incontinence, flatus incontinence was seen at follow up. Chi square test and t test were used to determine the significant difference between the groups.

Results: Both the groups were comparable to each other in terms of age, sex, presenting symptoms, mean duration of symptoms and internal findings. Diltiazem group patients had significantly much better healing rate i.e. 96.7% compared to only 80% from patients with   surgery group. Incidence of complications like fecal/flatus incontinence was zero in diltiazem group compared to 13.3%/20% in surgery group.

Conclusions: Authors conclude that diltiazem 2% topical application is better than surgical sphincterotomy and should be used instead of surgery.


Schouten WR, Briel JW, Auwerda JJ, De Graaf EJ. Ischemic nature of anal fissure. Br J Surg. 1996 Jan;83(1):63-5.

Tocchi A, Mazzoni G, Miccini M, Cassini D, Bettelli E, Brozzetti S. Total lateral sphincterotomy for anal fissure. Int J Colorectal Dis. 2004 May;19(3):245-9.

Jonas Marion, Scholefield JH. Taylor I, Johnson CD. Recent advances in Surgery. 24th Edition. Churchill Livingstone. Anal fissure and chemical sphincterotomy. 2001:115

Rakinic J. Anal fissure. Clin Colon Rectal Surg. 2007 May;20(2):133-7.

Perry WB, Dykes SL, Buie WD, Rafferty JF, Standards Practice Task Force of the American Society of Colon and Rectal Surgeons. Practice parameters for the management of anal fissures (3rd revision). Dis Colon Rectum. 2010 Aug;53(8):1110-5.

Nelson RL, Chattopadhyay A, Brooks W, Platt I, Paavana T, Earl S. Operative procedures for fissure in ano. Cochrane Database Syst Rev. 2011 Nov 9;(11):CD002199.

Publications.nice.org.uk. 2013. ESUOM3: Chronic anal fissure: 2% topical diltiazem hydrochloride key… ESUOM3. Available at: http://publications.nice.org.uk/esuom3-chronic-anal-fissure-2-topical-diltiazem-hydrochloride-esuom3. Accessed June 2017.

Giridhar CM, Preethitha Babu, Seshagiri Rao. A Comparative Study of lateral sphincterotomy and 2% diltiazem gel local application in the treatment of chronic fissure in ano. J Clin Diagn Res. 2014;8(10):NC01-NC02.

Vaithianathan R, Panneerselvam S. Randomised prospective controlled trial of topical 2% diltiazem versus lateral internal sphincterotomy for the treatment of chronic fissure in ano. Indian J Surg. 2015 Dec 1;77(3):1484-7.

Abhivardan D, Sivakumar VV, Rama Rao K, Balaji K, Sujatha M, Ramu L. A comparative study between 2% diltiazem application versus lateral sphincterotomy in fissure in ANO. Int J Contemporary Med Res 2017;4 (3):751-2.

Chauhan A, Tiwari S, Mishra VK, Bhatia PK. Comparison of internal sphincterotomy with topical diltiazem for post-hemorrhoidectomy pain relief: a prospective randomized trial. J Postgrad Med. 2009 Jan 1;55(1):22-6.

Gandomkar H, Zeinoddini A, Heidari R, Amoli HA. Partial lateral internal sphincterotomy versus combined botulinum toxin A injection and topical diltiazem in the treatment of chronic anal fissure: a randomized clinical trial. Dis Colon Rectum. 2015 Feb 1;58(2):228-34.






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