Management of chronic anal fissures: a narrative review

Authors

  • Hariharan Sritharan Department of General Surgery, Shri Sathya Sai Medical College and Research Institute, Ammapettai, Tamil Nadu
  • Naren Kumar Ashok Kumar Department of General Surgery, Shri Sathya Sai Medical College and Research Institute, Ammapettai, Tamil Nadu
  • Mohamed Ismail Syed Ibrahim Department of General Surgery, Shri Sathya Sai Medical College and Research Institute, Ammapettai, Tamil Nadu

DOI:

https://doi.org/10.18203/2349-2902.isj20201420

Keywords:

Chronic anal fissures, 2% diltiazem, Lateral anal sphincterotomy

Abstract

Anal fissures are often encountered in surgical practice in both sexes. It is a distressing disease impacting quality of life and causes profound morbidity among those affected. If left untreated, it may lead onto perianal abscess or even malignancy in long standing cases. Surgery is the gold standard management for chronic anal fissures. Recently the widespread use of pharmacologic agents for chronic fissures has increased. The management of chronic anal fissures has migrated to an era of multifaceted approach. This narrative review looks into various studies spanning over a period of 16 years. Various articles were shortlisted and analyzed for efficacy of various treatment methods, their impact in hospital stay, quality of life improvement, recurrence rate and complications among various treatment methods. We concluded from this review, that open lateral internal sphincterotomy is still the gold standard method of treatment for chronic anal fissure. Among pharmacological agents, 2% diltiazem has the best effectiveness with good compliance rate. Modern surgical techniques like VY plasty can be reserved for special situations. We do not recommend the practice of manual anal dilatation.

Author Biographies

Hariharan Sritharan, Department of General Surgery, Shri Sathya Sai Medical College and Research Institute, Ammapettai, Tamil Nadu

Department of General Surgery

Junior Resident

 

Mohamed Ismail Syed Ibrahim, Department of General Surgery, Shri Sathya Sai Medical College and Research Institute, Ammapettai, Tamil Nadu

professor

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Published

2020-03-26

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Section

Review Articles