![]() During defecation, the lesion is stretched with consequent painful symptomatology, which can persist for a certain amount of time and be accompanied by slight bleeding. Īnal fissure is very painful, because it affects the multilayer squamous epithelium of the anoderm, which is richly innervated with pain fibers. The commonly accepted definition of anal fissure is: “A linear ulcer of the anoderm, distal to the dentate line, generally located in the posterior midline”. Only a carefully selected group of patients, without anal hypertonia, could benefit from anoplasty. The risk of incontinence after this procedure seems to have been overemphasized in the past. Nonresponding patients should undergo lateral internal sphincterotomy. Use of 0.4% glyceryl trinitrate in standardized fashion seems to have the best results despite a higher percentage of headache, while the use of botulinum toxin had inconsistent results. While there is little chance of a cure with conservative behavioral therapy, medical treatment with calcium channel blockers, diltiazem and nifepidine or glyceryl trinitrate, had a considerable success rate ranging from 50 to 90%. This review is aimed at identifying the best treatment option drawing on evidence-based medicine and on the expert advice of 6 colorectal surgeons with extensive experience in this field in order to produce an Italian position statement for anal fissures. Despite some systematic reviews and an American position statement, there is ongoing debate about the best treatment for anal fissure. In the last decades, the understanding of its pathophysiology has led to a progressive reduction of invasive and potentially invalidating treatments in favor of conservative treatment based on anal sphincter muscle relaxation. Its treatment has long been discussed and several different therapeutic options have been proposed. However, all the options should be presented to the patient with complete information about the method, cure rates, complications, and reversibility of the complications and the final choice should be left in his hands.Anal fissure is one of the most common and painful proctologic diseases. ![]() Both methods are easy to perform, have negligible complications and no special setup is needed, except the radio surgical unit, in case of the first procedure. Revisiting the trends of treatment of chronic anal fissures, the most preferred options are the manual dilatation with radio surgery and the subcutaneous lateral anal sphincterotomy. The addition of radio surgery is found useful for refreshing the edges of the fissure and to tackle pathologies namely sentinel pile, small internal piles or hypertrophied anal papillae often found associated with chronic fissures. A new method combining the age-old technique of Lord's manual dilatation followed by radio surgery is also highlighted. About 10 different techniques are presented in brief with their efficacy and fallacy. To date, lateral sphincterotomy has been favoured by most of the proctologists, because it is the least extensive surgical procedure and is offering a long lasting relief in sphincter spasm. ![]() The efficacy claimed by each of the prevalent method is very high but the inconsistencies and contraindications are equally strong. Some of them are non-surgical while the others are surgical. There are many options to treat chronic fissures in ano.
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