Editorial
Copyright ©2010 Baishideng. All rights reserved.
World J Gastrointest Surg. Jul 27, 2010; 2(7): 231-241
Published online Jul 27, 2010. doi: 10.4240/wjgs.v2.i7.231
Innovations in chronic anal fissure treatment: A systematic review
Aaron Poh, Kok-Yang Tan, Francis Seow-Choen
Aaron Poh, Kok-Yang Tan, Department of Surgery, Khoo Teck Puat Hospital, Singapore 768828, Singapore
Francis Seow-Choen, Seow-Choen Colorectal Centre, Singapore 228510, Singapore
Author contributions: Poh A was the main author of this review; Tan KY and Seow-Choen F contributed to the concepts, drafting and review of this paper.
Correspondence to: Kok-Yang Tan, MBBS, MMed (Surg), FRCS, FAMS, Department of Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768828, Singapore. kokyangtan@gmail.com
Telephone: +65-66022207 Fax: +65-66023648
Received: March 3, 2010
Revised: July 15, 2010
Accepted: July 22, 2010
Published online: July 27, 2010
Abstract

A chronic anal fissure is a common perianal condition. This review aims to evaluate both existing and new therapies in the treatment of chronic fissures. Pharmacological therapies such as glyceryl trinitrate (GTN), Diltiazem ointment and Botulinum toxin provide a relatively non-invasive option, but with higher recurrence rates. Lateral sphincterotomy remains the gold standard for treatment. Anal dilatation has no role in treatment. New therapies include perineal support devices, Gonyautoxin injection, fissurectomy, fissurotomy, sphincterolysis, and flap procedures. Further research is required comparing these new therapies with existing established therapies. This paper recommends initial pharmacological therapy with GTN or Diltiazem ointment with Botulinum toxin as a possible second line pharmacological therapy. Perineal support may offer a new dimension in improving healing rates. Lateral sphincterotomy should be offered if pharmacological therapy fails. New therapies are not suitable as first line treatments, though they can be considered if conventional treatment fails.

Keywords: Anal fissure; Innovative therapy; Glyceryl trinitrate; Lateral sphincterotomy; Diltiazem; Botulinum toxin; Perineal support device