Innovations in chronic anal fissure treatment: A systematic review

Table 4 Studies comparing complication rates of different surgical therapies

S/N	Ref.	Study details	Results
1	Garcea et al[30] 2002 Single arm, retrospective, non-randomized	Conservative lateral sphincterotomy for chronic anal fissures 65 patients	Flatus or fecal incontinence-3.3%
2	Tocchi et al[31] 2004 Single arm, prospective, non-randomized	Lateral subcutaneous internal sphincterotomy for non-responders to 0.2% GTN 164 patients	Early gas and fecal soilage-9.1% Some degree of incontinence at 3 mo-3% (3/5 patients had pre-op external sphincter damage)
3	Liratzopoulos et al[32] 2006 Single arm, prospective, non-randomized	Lateral subcutaneous sphincterotomy for chronic anal fissures 246 patients	Incidence of new continence at 48 wk-7.02%
4	Wiley et al[33] 2004 Dual arm, prospective, randomized	Open vs closed lateral sphincterotomy 79 patients	Overall incontinence rate-6.8% (no significant difference between the 2 techniques)
5	Elsebae et al[38] 2007 Dual arm, prospective, randomized	Impact of the extent of division of internal anal sphincter on fecal incontinence 108 patients	Up till dentate line-10.86% incontinence rate Up till apex of fissure-2.17% incontinence rate
6	Jensen et al[34] 1984 Double arm, prospective, randomized	Lateral sphincterotomy vs simple anal dilatation	Flatus incontinence-0% (sphincterotomy) vs 28.6% (anal dilatation) Fecal incontinence-0% (sphincterotomy) vs 7.1% (anal dilatation) Fecal soiling of underwear-3.3% (sphincterotomy) vs 39.3% (anal dilatation) All above results statistically significant
7	Renzi et al[13] 2007 Double arm, prospective, randomized	Pneumatic balloon dilatation vs lateral sphincterotomy 53 patients	Fecal incontinence-0% (balloon dilatation) vs 16% (sphincterotomy)
8	Richard et al[35] 2000 Double arm, prospective, randomized	Internal sphincterotomy vs 0.25% GTN 90 patients	Headaches-84% (GTN) No incontinence complications Patient satisfaction-97% (sphincterotomy) vs 61% (GTN)
9	Evans et al[36] 2001 Dual arm, prospective, randomized	0.2% GTN vs lateral sphincterotomy for chronic anal fissures 65 patients	GTN-31% headaches No mention of sphincterotomy complications
10	Brown et al[37] 2007 Double arm, prospective, randomized, multi-centric	2% GTN vs lateral internal sphincterotomy at 6 years post-treatment 82 patients	No difference in fecal incontinence scoring between both groups No difference in symptoms of incontinence-16/24 (66.7%) (sphincterotomy) vs 18/27 (66.7%) (GTN)
11	Menteş et al[29] 2003 Double arm, prospective, randomized	Botulinum toxin 0.3 units/kg vs internal sphincterotomy 111 patients	Incontinence-8/50 (16%) patients (sphincterotomy) had transient flatus incontinence vs 0 (botulinum toxin)
12	Schiano di Visconte et al[14] 2009 Double arm, prospective, randomized	0.25% GTN and anal cryothermal dilators BD vs 0.4% GTN 60 patients	No incontinence reported
13	Yucel et al[15] 2009 Double arm, prospective, randomized	Controlled intermittent anal dilatation (CIAD) vs lateral sphincterotomy 40 patients	No incontinence reported
14	Singh et al[9] 2005 Single arm, prospective, non-randomized	Rotational flap for treatment of chronic anal fissures 21 patients	11.8% flap uptake failure with wound dehiscence No donor site complications No new incontinence complications post-op
15	Giordano et al[10] 2009 Single arm, prospective, non-randomized	Cutaneous advancement flap anoplasty for chronic anal fissures 51 patients	Suture line dehiscence-5.9% No incontinence complications
16	Pelta et al[11] 2007 Double arm, prospective, randomized	Subcutaneous fissurotomy for chronic anal fissures 109 patients	No incontinence complications
17	Soll et al[12] 2004 Single arm, prospective, non-randomized	Fissurectomy and botulinum toxin 20-25 units for chronic anal fissures not responsive to medical therapy 31 patients	7% flatus incontinence rate lasting maximum of 6 wk
18	Gupta[16] 2008 Single arm, prospective, non-randomized	Closed anal sphincter manipulation (sphincterolysis) for chronic anal fissures 312 patients	11/312 patients had incontinence symptoms within first 4 wk Complete continence restored in 97% of patients after 1 mo
19	Tan et al[7] 2009 Single arm, prospective, non-randomized	Effect of posterior perineal support on chronic anal fissure healing	No complications noted

GTN: Glyceryl trinitrate