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. 2023 Oct 13;23(1):311.
doi: 10.1186/s12893-023-02223-z.

The Italian Unitary Society of Colon-proctology (SIUCP: Società Italiana Unitaria di Colonproctologia) guidelines for the management of anal fissure

Antonio Brillantino #  1 , Adolfo Renzi #  2 , Pasquale Talento #  3 , Francesca Iacobellis  4 , Luigi Brusciano  5 , Luigi Monaco  6 , Domenico Izzo  7 , Alfredo Giordano  8 , Michele Pinto  9 , Corrado Fantini  10 , Marcello Gasparrini  11 , Michele Schiano Di Visconte  12 , Francesca Milazzo  3 , Giovanni Ferreri  3 , Andrea Braini  13 , Umberto Cocozza  14 , Massimo Pezzatini  15 , Valeria Gianfreda  16 , Alberto Di Leo  17 , Vincenzo Landolfi  18 , Umberto Favetta  19 , Sergio Agradi  20 , Giovanni Marino  21 , Massimilano Varriale  22 , Massimo Mongardini  23 , Claudio Eduardo Fernando Antonio Pagano  19 , Riccardo Brachet Contul  24 , Nando Gallese  25 , Giampiero Ucchino  26 , Michele D'Ambra  27 , Roberto Rizzato  28 , Giacomo Sarzo  29 , Bruno Masci  30 , Francesca Da Pozzo  31 , Simona Ascanelli  32 , Fabrizio Foroni  33 , Alessio Palumbo  33 , Patrizia Liguori  34 , Angela Pezzolla  35 , Luigi Marano  36 , Antonio Capomagi  37 , Eugenio Cudazzo  3 , Francesca Babic  38 , Carmelo Geremia  19 , Alessandro Bussotti  39 , Mario Cicconi  40 , Antonia Di Sarno  2 , Federico Maria Mongardini  5 , Antonio Brescia  41 , Leonardo Lenisa  42 , Massimiliano Mistrangelo  43 , Maria Laura Sandoval Sotelo  33 , Luciano Vicenzo  33 , Antonio Longo #  44 , Ludovico Docimo #  5
Affiliations

The Italian Unitary Society of Colon-proctology (SIUCP: Società Italiana Unitaria di Colonproctologia) guidelines for the management of anal fissure

Antonio Brillantino et al. BMC Surg. .

Abstract

Introduction: The aim of these evidence-based guidelines is to present a consensus position from members of the Italian Unitary Society of Colon-Proctology (SIUCP: Società Italiana Unitaria di Colon-Proctologia) on the diagnosis and management of anal fissure, with the purpose to guide every physician in the choice of the best treatment option, according with the available literature.

Methods: A panel of experts was designed and charged by the Board of the SIUCP to develop key-questions on the main topics covering the management of anal fissure and to performe an accurate search on each topic in different databanks, in order to provide evidence-based answers to the questions and to summarize them in statements. All the clinical questions were discussed by the expert panel in different rounds through the Delphi approach and, for each statement, a consensus among the experts was reached. The questions were created according to the PICO criteria, and the statements developed adopting the GRADE methodology.

Conclusions: In patients with acute anal fissure the medical therapy with dietary and behavioral norms is indicated. In the chronic phase of disease, the conservative treatment with topical 0.3% nifedipine plus 1.5% lidocaine or nitrates may represent the first-line therapy, eventually associated with ointments with film-forming, anti-inflammatory and healing properties such as Propionibacterium extract gel. In case of first-line treatment failure, the surgical strategy (internal sphincterotomy or fissurectomy with flap), may be guided by the clinical findings, eventually supported by endoanal ultrasound and anal manometry.

Keywords: Anal dilatation; Anal fissure; Anal manometry; Anal spasm; Endoanal ultrasound; Fissurectomy; SIUCP; Sphincterotomy.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Diagnostic and therapeutic algorithm for typical anal fissure. *According with the low grade of evidence supporting the preoperative morphological and functional investigations, the choice to perform both endoanal ultrasound and anal manometry should be considered optional in the clinical practice. Therefore, the evaluation of the anal tone may be carried out by digital examination and the detection of an associated local sepsis may be performed during surgery. **The choice to perform an anocutaneous flap may be based on surgeon preference and on intraoperative findings. Particularly, the addition of a flap should be carefully considered in presence of gross local infection. In these cases an isolated fissurectomy should be reasonably preferred
See this image and copyright information in PMC

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