title: A literature review on the role of chemical sphincterotomy after Milligan-Morgan hemorrhoidectomy.
abstract: OBJECTIVE
  A literature review of agents used to induce chemical sphincterotomy after hemorrhoidectomy.
  
  
  METHODS
  Electronic databases were searched from January 1935 to August 2010.
  
  
  RESULTS
  Two randomized controlled trials compared calcium channel blockers (Ca2) with placebo. Pain appeared to be less for up to 7 days, and its side-effect profile was comparable to the control group. Four randomized controlled trials examined the role of glyceryl trinitrate (GTN). GTN may be used up to 6 weeks to aid healing. Pain may be slightly less during its use and potentially offers less pain during defecation in the first 48 h. Its side-effect profile including headache appears comparable to placebo. Three randomized controlled trials investigated botulinum toxin A (BTX). BTX may be used to aid healing after hemorrhoidectomy. Pain may be less for up to a week after surgery. Its side-effect profile including incontinence to flatus appears comparable to placebo. It would be especially useful in cases where poor patient compliance is envisaged. Only one paper was found comparing BTX with GTN. BTX may be preferred over GTN due to better pain control and fewer side effects.
  
  
  CONCLUSIONS
  BTX, Ca2, and GTN may give effective pain relief for a week after hemorrhoidectomy. Their side-effect profiles are comparable to placebo.
authors.affiliation: Department of Colorectal Surgery, Mayday Hospital, Croydon, London CR7 7YE, UK. md0u812a@mac.com
authors.forename: Muhammad Rafay Sameem
authors.initials: MR
authors.lastname: Siddiqui
authors.forename: Chuk
authors.initials: C
authors.lastname: Abraham-Igwe
authors.forename: Arun
authors.initials: A
authors.lastname: Shangumanandan
authors.forename: Veronica
authors.initials: V
authors.lastname: Grassi
authors.forename: Ian
authors.initials: I
authors.lastname: Swift
authors.forename: Al Mutaz
authors.initials: AM
authors.lastname: Abulafi
mesh_terms: D001003:Anal Canal / Q000187:drug effects / Q000601:surgery*; D000698:Analgesia; D001905:Botulinum Toxins / Q000494:pharmacology / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000494:pharmacology / Q000627:therapeutic use; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D006287:Health Planning Guidelines; D006484:Hemorrhoids / Q000188:drug therapy / Q000601:surgery*; D006801:Humans; D005996:Nitroglycerin / Q000494:pharmacology / Q000627:therapeutic use; D010147:Pain Measurement; D011183:Postoperative Complications / Q000209:etiology; D016032:Randomized Controlled Trials as Topic; D014945:Wound Healing / Q000187:drug effects
chemical_list: D002121:Calcium Channel Blockers; D001905:Botulinum Toxins; D005996:Nitroglycerin