Innovations in chronic anal fissure treatment: A systematic review

Abstract

A chronic anal fissure is a common perianal condition. This review aims to evaluate both existing and new therapies in the treatment of chronic fissures. Pharmacological therapies such as glyceryl trinitrate (GTN), Diltiazem ointment and Botulinum toxin provide a relatively non-invasive option, but with higher recurrence rates. Lateral sphincterotomy remains the gold standard for treatment. Anal dilatation has no role in treatment. New therapies include perineal support devices, Gonyautoxin injection, fissurectomy, fissurotomy, sphincterolysis, and flap procedures. Further research is required comparing these new therapies with existing established therapies. This paper recommends initial pharmacological therapy with GTN or Diltiazem ointment with Botulinum toxin as a possible second line pharmacological therapy. Perineal support may offer a new dimension in improving healing rates. Lateral sphincterotomy should be offered if pharmacological therapy fails. New therapies are not suitable as first line treatments, though they can be considered if conventional treatment fails.

Comparative Study of Lateral Sphincterotomy versus Local 2 % Diltiazem Ointment for the Treatment of Chronic Anal Fissure

“…Pharmacological agents employed include nitrates (isosorbide dinitrate or glyceryl trinitrate), calcium channel blocker (nifedipine, diltiazem), and botulinum toxin etc. Surgical method most commonly employed is finger dilatation and lateral internal sphincterotomy, later being regarded as gold standard [5]. Other surgical methods developed include fissurectomy, local flap procedures such as V-Y advancement flap and rotation flaps [6,7].…”

Medical and Surgical Management of Anal Fissure - A Prospective Study

“…Richard et al shows healing rates of sphincterotomy range from 92% to 100% with majority of fissures healing within 2 months, which is similar to our result. [4][5][6][7][8][9][10][11][12][13] There was no incidence of incontinence for both flatus and faeces in both surgery groups. Haematoma was seen in 5 patients (1.2%) who underwent closed technique of LIS.…”

Comparison Between Lateral Internal Anal Sphincterotomy and Diltiazem in the Treatment of Chronic Anal Fissure

“…Lateral internal anal sphincterotomy is the most common treatment for chronic anal fissure and can be effective in more than 90% of cases. 3 The chief complication after this surgery is incontinence to faeces or flatus which has been reported in the range of 3.3 to 7%. 3 A variety of pharmacological agents have been found to cause reduction in tone of internal anal sphincter and probably aid in healing through an increase in local blood flow.…”

“…3 The chief complication after this surgery is incontinence to faeces or flatus which has been reported in the range of 3.3 to 7%. 3 A variety of pharmacological agents have been found to cause reduction in tone of internal anal sphincter and probably aid in healing through an increase in local blood flow. 4 The mediator of the non-adrenergic non-cholinergic pathway stimulating relaxation of the internal sphincter has been shown to be nitric oxide.…”