Effects of neuromodulation on treatment of recurrent anal fissure: A systematic review

Abstract

Background: Anal fissure is a linear tear in the distal anoderm most frequently occurring in the posterior midline. Lateral internal sphincterotomy is considered the gold standard for the treatment of this condition. To this date, several pharmacological and neuromodulatory therapies have been tried out as alternative non-invasive treatments for anal fissures, however, the efficacy of some of these methods remains to be understood.

Objective: the primary aim of this study was to review available literature on neuromodulatory treatments for recurrent anal fissure as a potentially effective cure for this condition.

Data sources: A search was conducted among five main online databases Embase, PubMed, Web of Science, Scopus, and Scholar.

Study selection: All published human studies in English literature addressing neuromodulation for the treatment of recurrent anal fissure were selected.

Intervention: neuromodulation for the treatment of anal fissure. We chose to include all articles in which the authors stated that the procedure they performed was via neuromodulation technique, or that the described technique used in their study resembled the technique.

Result: Among a total of 3487 evaluated studies, seven represented the effects of neuro modulation on treatment of recurrent anal fissure, among which two were randomized controlled trials and the rest were prospective studies. A total of 186 patient were evaluated in these studies. The mean age of the participants was 46.97 ± 8.2. The average VAS score before intervention was 7.77 ± 2.13, which decreased to 0.31 ± 1.13 after intervention.

Limitations: limitations of this study include the lack of related articles, and data regarding this subject.

Conclusion: Posterior tibial nerve stimulation (PTNS) provides rapid pain relief and fissure healing especially in short-to mid-terms with little to no complications, however, using this treatment, symptoms of anal fissure do not improve as well as LIS, especially in the long-term.

Keywords: Chronic anal fissure; Neuromodulation; Percutaneous posterior tibial nerve neurostimulation; Systematic review; Transcutaneous electrical nerve stimulation.