CHRONIC ANAL FISSURE TREATMENT

Introduction: Chronic anal fissure is defined as a laceration of the cutaneous layer of the anal canal lasting over six weeks, with sphincter hypertonia and anodermal ischemia. Treatment is based on reverting sphincter hypertonia, treatment and prevention of constipation and pain relief. Treatment may be medical, by applying topic Calcium Channel Blockers (CCB), nitroglycerin (NG) or botulinum toxin, or surgical. This work reviews the evidence on chronic anal fissure treatment. Method: We searched for guidelines, meta-analysis, review articles in Medline database using the terms Medical Subject Headings (MeSH) "Fissure in Ano/surgery" or "Fissure in Ano/therapy". We included studies from January 2013 to April 2015 and those comparING treatments for chronic anal fissure, both medical and surgical. We used Strength-of-Recommendation Taxonomy (SORT) from American Family Physician to rank our articles on strength of recommendation (SR) and evidence level (EL). Results and Conclusion: The search returned 86 articles, with 76 exclusions after reading their abstracts and purpose adequacy. 10 systematic reviews were analysed (N = 1070). These studies show that both NG and the CCB diminish the pain, with no identifiable superiority; the botulinium toxin LEADS to an efficient cicatrization, with no significant advantage over the CCB. Surgery proved beneficial when compared to CCB and/or NG and/or botulinium toxin administration. According to the Portuguese Coloproctology Society, fundamentals for treating chronic anal fissure are: sphincter hypertonia reversion, as well as treatment/prevention of constipation and promoting symptomatic relief. Both medical and surgical treatments reveal symptomatic improvement, surgery edging over medical treatment.