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. 2010 Jul 27;2(7):231-41.
doi: 10.4240/wjgs.v2.i7.231.

Innovations in chronic anal fissure treatment: A systematic review

Aaron Poh  1 , Kok-Yang Tan, Francis Seow-Choen
Affiliations

Innovations in chronic anal fissure treatment: A systematic review

Aaron Poh et al. World J Gastrointest Surg. .

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.

Keywords: Anal fissure; Botulinum toxin; Diltiazem; Glyceryl trinitrate; Innovative therapy; Lateral sphincterotomy; Perineal support device.

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Figures

Figure 1
Figure 1
Recommended treatment algorithm. GTN: Glyceryl trinitrate
See this image and copyright information in PMC

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