Chemical sphincterotomy with topical 2% diltiazem for chronic anal fissure: Our experience

Author : Madhusudhan M. Gopivallabh, Gananpathy Puranik

Background: Chronic anal fissure is a common problem across the world treated largely by surgical methods. Studies have demonstrated the efficacy of topical agents like Glyceryl-trinitrate in anal fissure but it has been shown to have side effects like headache and dizziness. There is a need for a pharmacological therapy for fissure which has fewer side effects. Hence, this study was taken up to assess the efficacy and adverse effects of topical 2% Diltiazem gel. Method: 50 patients with chronic anal fissure were considered for this study and they were treated with regular topical application of 2% Diltiazem gel. Patients were followed up at regular intervals for symptomatic relief and healing of fissure. Results: Fissure healed completely in 42 (89.36%) patients by 8 weeks. Of the 47 patients who applied Diltiazem, 13 (27.7%) were pain-free at the end of 4 weeks, 39 (83%) by 8 weeks and 42 (89.4%) by 14 weeks, while 5 (10.6%) patients remained symptomatic at the end of 14 weeks. However, mild headache (6.4%) and local irritation (4.3%) were noted. Conclusion: Topical 2% diltiazem gel is an effective agent in the treatment of chronic anal fissure. The need for hospital stay is abolished; psychological and financial burden on the patient is reduced. With a healing rate close to 90%, topical Diltiazem can be easily advised as the first line of treatment of chronic anal fissure.

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