Brief Answer:
You can ask for Diltigesic cream

Detailed Answer:
Hi.
Thanks for your query, albeit short and specific.

Apply Diltiazem Cream, 2 percent, ½ inch (marble size) amount to the perianal skin outside the anus twice a day for anal fissure.
I comes under many brand names. One of them is Diltigesic Organ gel, hence I think it can be used for anal fissure as it has the same composition as Diltiazem ointments or gels 2 %.

I hope this answers your query.
Also take other cares to be taken for healing of anal fissure:
Sitz bath,
Laxatives to keep stool soft.
No stress and.or anxiety is also an important part of treatment.

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Brief Answer:
As detailed below.

Detailed Answer:
Well, your query does not show any other information. There might have been a technical problem. No other details are seen other than the query you have mentioned above.
I have contacted the office to resolve the same.

Nice that you have posted the history in details.
To recapitulate the history you have noted now:
- Anal fissures for the last 6 months.
- Took Cifran CT twice daily for 3 weeks.
- Oral Isabgol, Cremaffin, Cremagel locally, Metrogyl inside
- Non stop sticky liquid discharge from anus 4 days back.
- Fistulogram is normal
- Changed the Doctor, Surgeon says go for surgery
- Physician says can be cured by medicines, prescribed antibiotic Ornof and also asked to continue with Isabgol powder, dufaloc, metrogel, diltigesic and trnivate-M to avoid itching.
- Sitz bath

Your queries:
Am I on right track?
> I do not think so. Since the problem is persistent for the last 6 months in spite of the medications you have been tried with means the changes in the internal sphincter have gone to the stage of fibrosis and sort of stricture.
Per-rectal examination by a General Surgeon can tell us whether the internal sphincter has gone into fibrosis meaning permanent stricture or is still pliable.
This gives the proper decision making whether to go for medication or for corrective surgery.
If the fissures are so old, have fibrosed internal sphincter and medications fail to give you cure, Surgery can help the most.

Will this problem be cured by medicine or surgery is a must?
> At the stage you have explained, surgery may be necessary if you want cure.

Third I have severe itching around anus and groin region. Is there any treatment?
> Because the peri-anal area is always covered the the buttock folds, you have applied so many medications locally, it is possible that the skin too has undergone multiple changes to give sort of a dermatitis and may be fungal skin infection of the peri-anal skin as well as of the skin of groin.
It can be treated as follows:
Clean the area with plain water 2-4 times a day, apply no soap or any ointments locally at the moment. Once cleared, make the area dry with a cotton cloth or hair dryer. You may apply Liquid Povidone Iodine locally and allow it to dry; this will make the area sterile.
Once the skin starts rejuvenating, the clear picture will tell what sort of problems were there and what treatment in may indicate: You can also take a second opinion of a Dermatologist for this.

I hope this answers all your queries that you have asked above. Please feel free to ask for further relevant queries if you still feel that there is a gap of communication.

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Brief Answer:
As detailed below.

Detailed Answer:
Thanks for your feedback and additional queries:
Cremagel is same as Diltigesic and contains Diltiazem 2 percent.
It probably is increasing the blood supply as it dilates the blood vessels and hence the increased blood flow washes away the allergen causing itching all over hence the itching vanishes. This is probable explanation.
This is worth noting and exploring.
(1) Pl clarify if itching (not just in groin but all over) is due to fissures.
> You have already consulted the Dermatologist who has actually seen the skin and has certified that you do not have any fungal or other issues. Hence this can be taken as an allergic only. Since the proverb says: anything under the sun including the sun can cause allergy. It is your observation that will help to get the cause and once you get it stop taking/using the causative factor/s.
It may not the fissure causing but may be the medications you are taking causing the reaction/itching.
May be stopping metrogel oral or local will help you.

Further, when I try applying Metrogel inside with finger, I do not get to feel if the ointment has really gone completely into the anus ( because it is water soluble). Also after such application I experience physical pain in the anus due to finger insertion. My next question is - (2) is this normal or how in what posture I should apply Metrogel into anus on the fissures.
> As a general rule your have to stop inserting anything in anus as it is causing pain, means hurting you and Metrogel may be one of the cause of pain and itching.

(3) what exactly is the effect of deltigesic on fissure cure . I have been told that it gets absorbed by perianal skin and then affects fissures to get cured. If so should I keep applying diltigesic every 5-6 hrs or for how many times in the day.
> It increases the local blood supply to the affected area and hence helps healing and relaxing. I do not think it helps in established fibrosis.

Lastly (4) what exactly is done for removing fissures during surgery? Do they cut anus ring and loosen it to allow larger hole to be formed?
> Depends upon the choice of the surgeon who will operate you.
Some do just anal dilatation
Some do internal sphincterotomy, meaning cut open internal sphincter only at one spot so that the tight ring effect goes away.
Some do Fissurectomy and so on as per the teachings, experiences, results they get hence your Surgeon can tell you exactly what he will do.
Please discuss in details with him.

I hope this helps you in clarifying your doubts.

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