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Multicenter Study
. 2024 Oct 4;28(1):139.
doi: 10.1007/s10151-024-03011-4.

Temporal trends and treatment patterns in anal fissure management: insights from a multicenter study in Italy

A Picciariello  1 , R Tutino  2 , G Gallo  3 , D F Altomare  4 , R Pietroletti  5 , A Dezi  4 , G Graziano  6 ; SICCR Anal Fissure Group; U Grossi  7
Collaborators, Affiliations
Multicenter Study

Temporal trends and treatment patterns in anal fissure management: insights from a multicenter study in Italy

A Picciariello et al. Tech Coloproctol. .

Abstract

Introduction: Anal fissure (AF) poses a common challenge in clinical practice, prompting various treatment approaches. This multicenter study, conducted by the Italian Society of Colorectal Surgery, aimed to assess treatment trends in AF over a 10 year period.

Methods: A survey of proctologists and retrospective analysis of patient records were conducted to evaluate treatment modalities and outcomes across six different clinical scenarios based on AF presentation (acute/chronic) stratified by sphincter function (normal/hypertonic/hypotonic).

Results: Analysis of data from 17 principal investigators and 22,016 patients revealed significant variability in treatment approaches, influenced by factors such as symptom duration, anal tone, and surgeon preference. Conservative treatments were commonly utilized, while surgical interventions were reserved for refractory cases. Specifically, pharmaceutical treatment was administered to 66-75% of patients in cases of acute AF and 63-67% for chronic AF, while 10-15% underwent anal dilation, and < 2% received botulinum toxin injection. Among medical treatments, nifedipine with lidocaine and glycerin film-forming ointments were the most utilized. The most performed surgical techniques were fissurectomy and anoplasty, except for patients with chronic AF and hypertonic sphincter where sphincterotomy prevailed. Trends in treatment utilization varied depending on the clinical scenario, with notable shifts observed over time.

Conclusions: This study provides insights into the evolving landscape of AF management, highlighting the need for further research to elucidate optimal treatment strategies and improve patient outcomes.

Keywords: Anal fissure; Botulinum toxin injection; Conservative treatment; Fissurectomy; Sphincterotomy; Surgery; Trends.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Trend of the different medical and surgical treatments over time and predicted probability model for scenario A (normal sphincter function)
Fig. 2
Fig. 2
Trend of the different medical and surgical treatments over time and predicted probability model for scenario B (hypertonic internal anal sphincter)
Fig. 3
Fig. 3
Trend of the different medical and surgical treatments over time and predicted probability model for scenario C (hypotonic anal sphincter)
Fig. 4
Fig. 4
Trend of the different medical and surgical treatments over time and predicted probability model for scenario D (normal sphincter function)
Fig. 5
Fig. 5
Trend of the different medical and surgical treatments over time and predicted probability model for scenario E (hypertonic internal anal sphincter)
Fig. 6
Fig. 6
Trend of the different medical and surgical treatments over time and predicted probability model for scenario F (hypotonic anal sphincter)
See this image and copyright information in PMC

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