Chronic anal fissure: 1994 and a decade later—are we doing better?

• Published in: The American journal of surgery Vol. 191; no. 3; pp. 344 - 348
• Main Authors: Floyd, Nadine Duhan, Kondylis, Laurie, Kondylis, Philip D., Reilly, John C.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2006; Elsevier Limited
• Subjects: Administration, Topical; Anal fissure; Botulinum toxin; Botulinum Toxins, Type A - therapeutic use; Calcium Channel Blockers - therapeutic use; Calcium-channel blockers; Chronic Disease; Combined Modality Therapy; Decision Making; Female; Fissure in Ano - drug therapy; Fissure in Ano - surgery; Healing; Humans; Male; Medical disorders; Medical treatment; Meta-analysis; Middle Aged; Neuromuscular Agents - therapeutic use; Nitrates; Nitrates - therapeutic use; Pain; Patients; Recurrence; Retrospective Studies; Sphincterotomy; Surgery; Treatment Outcome; Wound Healing; Recurrence; Anal fissure; Healing; Nitrates; Sphincterotomy; Calcium-channel blockers; Botulinum toxin
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2005.10.035

Debate exists regarding whether the use of topical agents and Botox injections are as efficacious as sphincterotomy for the treatment of chronic anal fissure. A retrospective review was performed to assess changes in management and outcomes of chronic anal fissure care in a community based colorectal practice between the individual years 1994 and 2003. Forty-seven patients in 1994 underwent lateral partial internal sphincterotomy and had a 100% healing rate. Thirty-nine patients were treated in 2003, with 32 undergoing Botox injection and 7 undergoing sphincterotomy initially. Of the Botox patients, 35% had recurrence, and 7 subsequently required sphincterotomy. Ultimate healing rates in 2003 were 97%. Time to heal was markedly prolonged in 2003 compared with 1994. Complication rates were similar, and there was no lifestyle-altering incontinence. Our review documents a significant change in the community approach to chronic fissure management. The addition of multiple treatment modalities prolongs time to healing from initial evaluation, but they allowed 72% of patients to avoid the need for permanent sphincter division while maintaining ultimate rates of healing.